Healthcare Provider Details

I. General information

NPI: 1679564959
Provider Name (Legal Business Name): ROBERT JEAN PERIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 11/04/2005
Last Update Date: 07/08/2007
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:
Title or Position:
Credential:
Phone: