Provider Demographics
NPI:1982341509
Name:PERRY, THARON CAMAAL (CEO)
Entity Type:Individual
Prefix:
First Name:THARON
Middle Name:CAMAAL
Last Name:PERRY
Suffix:
Gender:M
Credentials:CEO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1275 ROCK AVE APT C5
Mailing Address - Street 2:
Mailing Address - City:NORTH PLAINFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07060-3541
Mailing Address - Country:US
Mailing Address - Phone:908-549-9583
Mailing Address - Fax:
Practice Address - Street 1:1275 ROCK AVE APT C5
Practice Address - Street 2:
Practice Address - City:NORTH PLAINFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07060-3541
Practice Address - Country:US
Practice Address - Phone:908-549-9583
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-16
Last Update Date:2022-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJP27597366303832172A00000X
NJ343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No172A00000XOther Service ProvidersDriver