Provider Demographics
NPI:1215729124
Name:PERROTTA, NICOLAS
Entity type:Individual
Prefix:
First Name:NICOLAS
Middle Name:
Last Name:PERROTTA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:329 ANDREW PL
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGDALE
Mailing Address - State:NJ
Mailing Address - Zip Code:07403-1563
Mailing Address - Country:US
Mailing Address - Phone:973-907-0837
Mailing Address - Fax:
Practice Address - Street 1:329 ANDREW PL
Practice Address - Street 2:
Practice Address - City:BLOOMINGDALE
Practice Address - State:NJ
Practice Address - Zip Code:07403-1563
Practice Address - Country:US
Practice Address - Phone:973-907-0837
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-19
Last Update Date:2025-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program