Provider Demographics
NPI:1689743585
Name:PARISI, GERARD MICHAEL (DPM)
Entity Type:Individual
Prefix:DR
First Name:GERARD
Middle Name:MICHAEL
Last Name:PARISI
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 POMPTON AVE
Mailing Address - Street 2:STE 25
Mailing Address - City:CEDAR GROVE
Mailing Address - State:NJ
Mailing Address - Zip Code:07009-2042
Mailing Address - Country:US
Mailing Address - Phone:973-239-1307
Mailing Address - Fax:973-239-5727
Practice Address - Street 1:6 POMPTON AVE
Practice Address - Street 2:STE 25
Practice Address - City:CEDAR GROVE
Practice Address - State:NJ
Practice Address - Zip Code:07009-2042
Practice Address - Country:US
Practice Address - Phone:973-239-1307
Practice Address - Fax:973-239-5727
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25 MD00123100213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
T44794Medicare UPIN
T44794Medicare ID - Type Unspecified