Provider Demographics
NPI:1831538107
Name:PEREZ-PUERTA, JENY (RN)
Entity type:Individual
Prefix:MRS
First Name:JENY
Middle Name:
Last Name:PEREZ-PUERTA
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 ZABRISKIE PL
Mailing Address - Street 2:
Mailing Address - City:RIVER EDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07661-1734
Mailing Address - Country:US
Mailing Address - Phone:201-951-4479
Mailing Address - Fax:
Practice Address - Street 1:215 ZABRISKIE PL
Practice Address - Street 2:
Practice Address - City:RIVER EDGE
Practice Address - State:NJ
Practice Address - Zip Code:07661-1734
Practice Address - Country:US
Practice Address - Phone:201-951-4479
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-20
Last Update Date:2013-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY670812-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse