Provider Demographics
NPI:1861467664
Name:PERTCHIK, ALAN FRANCIS (MD)
Entity Type:Individual
Prefix:DR
First Name:ALAN
Middle Name:FRANCIS
Last Name:PERTCHIK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:66 MANITTO PL
Mailing Address - Street 2:
Mailing Address - City:OCEANPORT
Mailing Address - State:NJ
Mailing Address - Zip Code:07757-1545
Mailing Address - Country:US
Mailing Address - Phone:732-229-6693
Mailing Address - Fax:732-229-3611
Practice Address - Street 1:43 N GILBERT ST
Practice Address - Street 2:
Practice Address - City:TINTON FALLS
Practice Address - State:NJ
Practice Address - Zip Code:07701-4913
Practice Address - Country:US
Practice Address - Phone:732-741-3344
Practice Address - Fax:732-741-3845
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA282702084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ4683401Medicaid
NJPE102765Medicare ID - Type Unspecified
C53256Medicare UPIN