Basic Information
| Provider Information | |||||||||
| NPI: | 1457767626 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DONENFELD | ||||||||
| FirstName: | PERRI | ||||||||
| MiddleName: | |||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1000 HADDONFIELD BERLIN RD STE 210 | ||||||||
| Address2: | |||||||||
| City: | VOORHEES | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 080433520 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8567822212 | ||||||||
| FaxNumber: | 8567822266 | ||||||||
| Practice Location | |||||||||
| Address1: | 1000 HADDONFIELD BERLIN RD STE 210 | ||||||||
| Address2: | |||||||||
| City: | VOORHEES | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 080433520 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8567822212 | ||||||||
| FaxNumber: | 8567822266 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/08/2014 | ||||||||
| LastUpdateDate: | 04/16/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/16/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | OS017584 | PA | N | Allopathic & Osteopathic Physicians | Pediatrics | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 2080N0001X | 25MD10312900 | NJ | Y | Allopathic & Osteopathic Physicians | Pediatrics | Neonatal-Perinatal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 0635511 | 05 | NJ | MEDICAID |