Provider Demographics
NPI:1932386729
Name:PEREZ-HERRANZ, DAVID (PT)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:PEREZ-HERRANZ
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:981 RTE 22 FL 2
Mailing Address - Street 2:
Mailing Address - City:BRIDGEWATER
Mailing Address - State:NJ
Mailing Address - Zip Code:08807-2946
Mailing Address - Country:US
Mailing Address - Phone:201-801-7141
Mailing Address - Fax:732-218-5322
Practice Address - Street 1:9920 4TH AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11209-8333
Practice Address - Country:US
Practice Address - Phone:718-238-9873
Practice Address - Fax:718-238-9359
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-24
Last Update Date:2021-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA02028700225100000X
NY030017-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist