Provider Demographics
NPI:1013123702
Name:JOSE M SOTO-PERELLO, MD CORPORATION
Entity Type:Organization
Organization Name:JOSE M SOTO-PERELLO, MD CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:M
Authorized Official - Last Name:SOTO-PERELLO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-864-4897
Mailing Address - Street 1:516 51ST ST
Mailing Address - Street 2:
Mailing Address - City:WEST NEW YORK
Mailing Address - State:NJ
Mailing Address - Zip Code:07093-5553
Mailing Address - Country:US
Mailing Address - Phone:201-864-4897
Mailing Address - Fax:201-864-4871
Practice Address - Street 1:516 51ST ST
Practice Address - Street 2:
Practice Address - City:WEST NEW YORK
Practice Address - State:NJ
Practice Address - Zip Code:07093-5553
Practice Address - Country:US
Practice Address - Phone:201-864-4897
Practice Address - Fax:201-864-4871
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-16
Last Update Date:2013-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA070181002084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ=========OtherTAX ID
NJ091390Medicare PIN
NJB19121Medicare UPIN
NJ055920UABMedicare PIN