Provider Demographics
NPI:1760407670
Name:LOESBERG, PERRY (MD)
Entity Type:Individual
Prefix:
First Name:PERRY
Middle Name:
Last Name:LOESBERG
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:PO BOX 18736
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07191-8736
Mailing Address - Country:US
Mailing Address - Phone:800-426-1699
Mailing Address - Fax:
Practice Address - Street 1:601 HAMILTON AVE
Practice Address - Street 2:
Practice Address - City:TRENTON
Practice Address - State:NJ
Practice Address - Zip Code:08629-1915
Practice Address - Country:US
Practice Address - Phone:609-599-5097
Practice Address - Fax:609-599-6312
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2011-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06337000207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0708933000OtherKHPE, PERSONAL CHOICE, AMERIHEALTH
PA22-1994560OtherDEVON
PA22-1994560OtherFIRST MCO
NJ22-1994560OtherHORIZON BLUECROSS/BLUE SHIELD OF NEW JERSEY
NJ1826899OtherAETNA NJ
PA22-1994560OtherGREAT WEST HEALTHCARE
PA5801633OtherCIGNA
PA22-1994560OtherUNITED HEALTHCARE/OXFORD
PA22-1994560OtherPROCURA MANAGEMENT
NJ22-1994560OtherFIRST MCO
NJ22-1994560OtherUNITED HEALTHCARE/OXFORD
NJ6143105Medicaid
PA22-1994560OtherHEALTH AMERICA/HEALTH ASSURANCE
PA50085438OtherCAPITAL BLUE CROSS
PA733912OtherFIRST HEALTH NETWORK
PA1726512OtherAETNA
PALO765151OtherHIGHMARK BLUE SHIELD
NJ22-1994560OtherHORIZON BLUECROSS/BLUE SHIELD OF NEW JERSEY
PA200412GDNMedicare PIN
PA765151Medicare PIN
PA22-1994560OtherHEALTH AMERICA/HEALTH ASSURANCE
NJ22-1994560OtherFIRST MCO
PA5801633OtherCIGNA
PA733912OtherFIRST HEALTH NETWORK