Provider Demographics
NPI:1770546301
Name:PEREZ, JAMES
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:
Last Name:PEREZ
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 1:824 ELIZABETH AVE
Mailing Address - Street 2:
Mailing Address - City:ELIZABETH
Mailing Address - State:NJ
Mailing Address - Zip Code:07201-4708
Mailing Address - Country:US
Mailing Address - Phone:908-352-9556
Mailing Address - Fax:908-352-9134
Practice Address - Street 1:824 ELIZABETH AVE
Practice Address - Street 2:
Practice Address - City:ELIZABETH
Practice Address - State:NJ
Practice Address - Zip Code:07201-2709
Practice Address - Country:US
Practice Address - Phone:908-352-9556
Practice Address - Fax:908-352-9134
Is Sole Proprietor?:No
Enumeration Date:2006-04-06
Last Update Date:2017-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA04302500207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJE-13349Medicare UPIN
NJPE549779Medicare ID - Type Unspecified
NJ1435205Medicare ID - Type Unspecified