Healthcare Provider Details

I. General information

NPI: 1851165187
Provider Name (Legal Business Name): MIGUEL ANGEL PEREZ GONZALEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/07/2023
Last Update Date: 04/01/2025
Certification Date: 04/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

248 MARLIN RD
ABSECON NJ
08201-2508
US

IV. Provider business mailing address

1925 PACIFIC AVE
ATLANTIC CITY NJ
08401-6713
US

V. Phone/Fax

Practice location:
  • Phone: 609-369-3976
  • Fax:
Mailing address:
  • Phone: 609-407-2243
  • Fax: 609-593-9850

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number26NR18905700
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number26NJ15100300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: