Provider Demographics
NPI:1790819688
Name:PERRY, LINDA ALICE (CNM)
Entity Type:Individual
Prefix:MS
First Name:LINDA
Middle Name:ALICE
Last Name:PERRY
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:LINDA
Other - Middle Name:
Other - Last Name:PERRY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNM
Mailing Address - Street 1:2 LINCOLN TER
Mailing Address - Street 2:
Mailing Address - City:CALDWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:07006-5611
Mailing Address - Country:US
Mailing Address - Phone:973-641-2003
Mailing Address - Fax:855-864-2512
Practice Address - Street 1:307 BLOOMFIELD AVE STE 301
Practice Address - Street 2:
Practice Address - City:CALDWELL
Practice Address - State:NJ
Practice Address - Zip Code:07006-5165
Practice Address - Country:US
Practice Address - Phone:862-359-9160
Practice Address - Fax:855-864-2515
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-15
Last Update Date:2023-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF001143-1176B00000X
NY404616363LP0808X
NJ25ME00060001367A00000X
NJ26NJ01403000363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No176B00000XOther Service ProvidersMidwife
No367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife