Provider Demographics
NPI:1962446344
Name:PERNELLI, DAVID ROBERT (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:ROBERT
Last Name:PERNELLI
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 1:3071 E CHESTNUT AVE
Mailing Address - Street 2:SUITE B 6
Mailing Address - City:VINELAND
Mailing Address - State:NJ
Mailing Address - Zip Code:08361-7847
Mailing Address - Country:US
Mailing Address - Phone:856-205-1100
Mailing Address - Fax:856-205-9163
Practice Address - Street 1:3071 E CHESTNUT AVE
Practice Address - Street 2:SUITE B 6
Practice Address - City:VINELAND
Practice Address - State:NJ
Practice Address - Zip Code:08361-7847
Practice Address - Country:US
Practice Address - Phone:856-205-1100
Practice Address - Fax:856-205-9163
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-15
Last Update Date:2013-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA56275207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJE84898Medicare UPIN
NJPE670631Medicare ID - Type Unspecified