Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207K00000X | Allergist & Immunologist | MA055073 | NJ |
NPI | 1093892465 |
---|---|
Provider Name | Patrick V. Perin |
First Address | Charlotte, NC 28260-3725 |
Second Address | Teaneck, NJ 07666-1712 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/11/2006 |
Last Update Date | 10/05/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0431711 | (05) | NJ |
651311ZKRP | MEDICARE PTAN (01) | NJ |