Provider Demographics
NPI:1821343799
Name:CORTORREAL, PERFECTO (MSED)
Entity Type:Individual
Prefix:
First Name:PERFECTO
Middle Name:
Last Name:CORTORREAL
Suffix:
Gender:M
Credentials:MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:151 E MADISON AVE
Mailing Address - Street 2:
Mailing Address - City:DUMONT
Mailing Address - State:NJ
Mailing Address - Zip Code:07628-2535
Mailing Address - Country:US
Mailing Address - Phone:201-244-5202
Mailing Address - Fax:201-244-5202
Practice Address - Street 1:151 E MADISON AVE
Practice Address - Street 2:
Practice Address - City:DUMONT
Practice Address - State:NJ
Practice Address - Zip Code:07628-2535
Practice Address - Country:US
Practice Address - Phone:201-244-5202
Practice Address - Fax:201-244-5202
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-17
Last Update Date:2012-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist