Provider Demographics
NPI:1255396982
Name:PEREZ, WALTER (MD)
Entity type:Individual
Prefix:DR
First Name:WALTER
Middle Name:
Last Name:PEREZ
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:PO BOX 213
Mailing Address - Street 2:
Mailing Address - City:HARRISON
Mailing Address - State:NJ
Mailing Address - Zip Code:07029-0213
Mailing Address - Country:US
Mailing Address - Phone:973-350-0800
Mailing Address - Fax:973-350-0885
Practice Address - Street 1:213 HARRISON AVE
Practice Address - Street 2:
Practice Address - City:HARRISON
Practice Address - State:NJ
Practice Address - Zip Code:07029-1340
Practice Address - Country:US
Practice Address - Phone:973-350-0800
Practice Address - Fax:973-350-0885
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-18
Last Update Date:2022-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06952400207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2K7705OtherHEALTH NET
NJ3802206OtherAETNA HMO
NJ6953243OtherCIGNA HEALTHCARE
NJ63584Medicaid
NJP3564059OtherOXFORD
NJ7815248OtherAETNA PPO
NJ108244OtherAMERIGROUP OF NJ
NJ8223205OtherGHI
NJ34730OtherUNITED HEALTH CARE
NJ2143265OtherUNITED HEALTH CARE
NJ2412578001OtherAMERIHEALTH OF NJ
NJ1000748500OtherAMERICHOICE OF NJ
NJ8223205OtherGHI
NJ090161T5FMedicare PIN