Provider Demographics
NPI:1447200878
Name:HERMAN, PERRY M (MD)
Entity Type:Individual
Prefix:
First Name:PERRY
Middle Name:M
Last Name:HERMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:666 PLAINSBORO RD
Mailing Address - Street 2:STE 1210
Mailing Address - City:PLAINSBORO
Mailing Address - State:NJ
Mailing Address - Zip Code:08536-3046
Mailing Address - Country:US
Mailing Address - Phone:609-655-1500
Mailing Address - Fax:609-655-4900
Practice Address - Street 1:18 CENTRE DR
Practice Address - Street 2:SUITE 207
Practice Address - City:MONROE TOWNSHIP
Practice Address - State:NJ
Practice Address - Zip Code:08831-1564
Practice Address - Country:US
Practice Address - Phone:609-655-1500
Practice Address - Fax:609-655-4900
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-10
Last Update Date:2019-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07536800174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ069870Medicare ID - Type UnspecifiedMEDICARE
NJH24730Medicare UPIN