Provider Demographics
NPI:1467414128
Name:WALTER PEREZ, M.D., L.L.C.
Entity Type:Organization
Organization Name:WALTER PEREZ, M.D., L.L.C.
Other - Org Name:WALTER PEREZ, M.D LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:INES
Authorized Official - Middle Name:
Authorized Official - Last Name:PEREZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-868-6597
Mailing Address - Street 1:PO BOX 213
Mailing Address - Street 2:
Mailing Address - City:HARRISON
Mailing Address - State:NJ
Mailing Address - Zip Code:07029-0213
Mailing Address - Country:US
Mailing Address - Phone:973-350-0800
Mailing Address - Fax:973-350-0885
Practice Address - Street 1:213 HARRISON AVE
Practice Address - Street 2:
Practice Address - City:HARRISON
Practice Address - State:NJ
Practice Address - Zip Code:07029-1340
Practice Address - Country:US
Practice Address - Phone:973-350-0800
Practice Address - Fax:973-350-0885
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WALTER PEREZ, M.D LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-04-06
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6953243OtherCIGNA
P3564059OtherOXFORD
NJ01000748501OtherAMERICHOICE
NJ34730OtherUNIVERSITY HEALTH PLANS
NJ2143265OtherUNITED HEALTH CARE
NJ2412577000OtherAMERIHEALTH PPO
NJ2412577001OtherAMERIHEALTH HMO
NJ8223205OtherGHI
NJ2K7705OtherHEALTH NET
NJ60013238OtherHORIZON NJ HEALTH
NJ8223205OtherGHI