Provider Demographics
NPI:1831307503
Name:PEREZ, MARIA NOREEN
Entity Type:Individual
Prefix:
First Name:MARIA NOREEN
Middle Name:
Last Name:PEREZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 BOONTON AVE
Mailing Address - Street 2:
Mailing Address - City:BUTLER
Mailing Address - State:NJ
Mailing Address - Zip Code:07405-1432
Mailing Address - Country:US
Mailing Address - Phone:347-213-3655
Mailing Address - Fax:
Practice Address - Street 1:81 OAK DR
Practice Address - Street 2:SUITE B
Practice Address - City:CEDAR GROVE
Practice Address - State:NJ
Practice Address - Zip Code:07009-1033
Practice Address - Country:US
Practice Address - Phone:973-704-5758
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-18
Last Update Date:2012-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01204400225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist