Provider Demographics
NPI:1508426347
Name:PEREIRA, PATRICK (DPT)
Entity Type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:
Last Name:PEREIRA
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1111 US HIGHWAY 22
Mailing Address - Street 2:
Mailing Address - City:MOUNTAINSIDE
Mailing Address - State:NJ
Mailing Address - Zip Code:07092-2808
Mailing Address - Country:US
Mailing Address - Phone:908-389-9100
Mailing Address - Fax:
Practice Address - Street 1:300 SOUTH AVE STE 14
Practice Address - Street 2:
Practice Address - City:GARWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07027-1349
Practice Address - Country:US
Practice Address - Phone:908-789-1700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-14
Last Update Date:2019-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01859700225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist