Provider Demographics
NPI:1467409409
Name:PERLIN, ADAM JAY (OD)
Entity Type:Individual
Prefix:DR
First Name:ADAM
Middle Name:JAY
Last Name:PERLIN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4000 GYPSY LN
Mailing Address - Street 2:UNIT 548
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19129-5460
Mailing Address - Country:US
Mailing Address - Phone:215-432-4048
Mailing Address - Fax:
Practice Address - Street 1:1192 WHITE HORSE RD
Practice Address - Street 2:
Practice Address - City:VOORHEES
Practice Address - State:NJ
Practice Address - Zip Code:08043-2104
Practice Address - Country:US
Practice Address - Phone:856-428-0100
Practice Address - Fax:856-428-6788
Is Sole Proprietor?:No
Enumeration Date:2006-05-27
Last Update Date:2010-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27OA00541200152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7855508Medicaid
NJU57942Medicare UPIN
NJ7855508Medicaid