Provider Demographics
NPI:1669684908
Name:PERELMAN, IRINA (OD)
Entity type:Individual
Prefix:DR
First Name:IRINA
Middle Name:
Last Name:PERELMAN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:IRINA
Other - Middle Name:
Other - Last Name:PERELMAN-GRABOIS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OD
Mailing Address - Street 1:90 MAIN ST
Mailing Address - Street 2:STE 104
Mailing Address - City:HACKENSACK
Mailing Address - State:NJ
Mailing Address - Zip Code:07601-7130
Mailing Address - Country:US
Mailing Address - Phone:201-488-7119
Mailing Address - Fax:201-525-5214
Practice Address - Street 1:90 MAIN ST
Practice Address - Street 2:STE 104
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601-7130
Practice Address - Country:US
Practice Address - Phone:201-488-7119
Practice Address - Fax:201-525-5214
Is Sole Proprietor?:No
Enumeration Date:2007-05-06
Last Update Date:2018-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27OA00503300152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ911671OtherEYE MED PROVIDER NUMBER
NJU54069Medicare UPIN
NJ612350Medicare ID - Type UnspecifiedNONE