Basic Information
| Provider Information | |||||||||
| NPI: | 1861501470 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PERLMAN | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | D | ||||||||
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| Credential: | DPM | ||||||||
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| Mailing Information | |||||||||
| Address1: | 939 KENNEDY BOULEVARD | ||||||||
| Address2: | |||||||||
| City: | NORTH BERGEN | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 07047 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2018642484 | ||||||||
| FaxNumber: | 2018646460 | ||||||||
| Practice Location | |||||||||
| Address1: | 939 KENNEDY BOULEVARD | ||||||||
| Address2: | |||||||||
| City: | NORTH BERGEN | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 07047 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2018642484 | ||||||||
| FaxNumber: | 2018646460 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/29/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 213E00000X | 25MD00156000 | NJ | Y | Podiatric Medicine & Surgery Service Providers | Podiatrist |
ID Information
| ID | Type | State | Issuer | Description | 0056770 | 01 | GHI | OTHER |