Provider Demographics
NPI:1740459494
Name:JERRY PERLMUTTER D P M P A
Entity type:Organization
Organization Name:JERRY PERLMUTTER D P M P A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DR OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:MARTIN
Authorized Official - Last Name:PERLMUTTER
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:954-974-0494
Mailing Address - Street 1:5800 COLONIAL DR
Mailing Address - Street 2:SUITE 203
Mailing Address - City:MARGATE
Mailing Address - State:FL
Mailing Address - Zip Code:33063-5674
Mailing Address - Country:US
Mailing Address - Phone:954-974-0494
Mailing Address - Fax:954-972-4498
Practice Address - Street 1:5800 COLONIAL DR
Practice Address - Street 2:SUITE 203
Practice Address - City:MARGATE
Practice Address - State:FL
Practice Address - Zip Code:33063-5674
Practice Address - Country:US
Practice Address - Phone:954-974-0494
Practice Address - Fax:954-972-4498
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-27
Last Update Date:2009-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO1173213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
T55507Medicare UPIN
FL4604650001Medicare NSC