Provider Demographics
NPI:1609945294
Name:PERELMAN, JEFFREY ROBERT (MD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:ROBERT
Last Name:PERELMAN
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 1:98 S FEDERAL HWY
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33432-4825
Mailing Address - Country:US
Mailing Address - Phone:561-542-5933
Mailing Address - Fax:561-338-2476
Practice Address - Street 1:98 S FEDERAL HWY
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33432-4825
Practice Address - Country:US
Practice Address - Phone:561-620-4798
Practice Address - Fax:561-338-2476
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-07
Last Update Date:2009-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME51866174400000X
FL051866208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
E30556Medicare UPIN