Healthcare Provider Details

I. General information

NPI: 1750342697
Provider Name (Legal Business Name): REED C PERRON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2006
Last Update Date: 04/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 EAST RIDGEWOOD AVE EAST WING 2ND FLOOR
RIDGEWOOD NJ
07450
US

IV. Provider business mailing address

1200 EAST RIDGEWOOD AVE EAST WING 2ND FLOOR
RIDGEWOOD NJ
07450
US

V. Phone/Fax

Practice location:
  • Phone: 201-444-0868
  • Fax: 201-493-0797
Mailing address:
  • Phone: 201-444-0868
  • Fax: 201-493-0797

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberMA27670
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: