Provider Demographics
NPI:1720034606
Name:PERIUT, RICHARD (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:
Last Name:PERIUT
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 1:44 FRANKLIN ST
Mailing Address - Street 2:
Mailing Address - City:LITTLE FERRY
Mailing Address - State:NJ
Mailing Address - Zip Code:07643-1218
Mailing Address - Country:US
Mailing Address - Phone:201-512-9494
Mailing Address - Fax:201-512-1995
Practice Address - Street 1:3701 PARK AVE
Practice Address - Street 2:
Practice Address - City:UNION CITY
Practice Address - State:NJ
Practice Address - Zip Code:07087-6021
Practice Address - Country:US
Practice Address - Phone:201-440-2222
Practice Address - Fax:201-440-2282
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-25
Last Update Date:2008-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA68984207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8964807Medicaid
NJ8964807Medicaid
NJ063454Medicare ID - Type Unspecified