Healthcare Provider Details

I. General information

NPI: 1124000930
Provider Name (Legal Business Name): ROBERT J PERIN MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/17/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

630 SALEM AVE
WOODBURY NJ
08096-3118
US

IV. Provider business mailing address

630 SALEM AVE
WOODBURY NJ
08096-3118
US

V. Phone/Fax

Practice location:
  • Phone: 856-845-8300
  • Fax: 856-845-2512
Mailing address:
  • Phone: 856-845-8300
  • Fax: 856-845-2512

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License NumberMA37634
License Number StateNJ

VIII. Authorized Official

Name: ROBERT J PERIN
Title or Position: PRESIDENT
Credential: MD
Phone: 856-845-8300