Provider Demographics
NPI:1548575822
Name:PERDOMO, MARC (DPT)
Entity Type:Individual
Prefix:MR
First Name:MARC
Middle Name:
Last Name:PERDOMO
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 1:116 OCEANPORT AVE
Mailing Address - Street 2:
Mailing Address - City:LITTLE SILVER
Mailing Address - State:NJ
Mailing Address - Zip Code:07739-1211
Mailing Address - Country:US
Mailing Address - Phone:732-758-0002
Mailing Address - Fax:732-219-0979
Practice Address - Street 1:116 OCEANPORT AVE
Practice Address - Street 2:
Practice Address - City:LITTLE SILVER
Practice Address - State:NJ
Practice Address - Zip Code:07739-1211
Practice Address - Country:US
Practice Address - Phone:732-758-0002
Practice Address - Fax:732-219-0979
Is Sole Proprietor?:No
Enumeration Date:2010-08-11
Last Update Date:2010-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01364500225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist