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General NPI Number Information
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NPI Number | 1609340363
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Entity Type | Individual
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Provider Name | KATHLEEN L PEREZ RTT
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Gender | Female
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Dates
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Enumeration Date | 01/16/2019
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Last Update Date | 06/02/2022
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Provider Practice Location Address
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Address Line | 505 OMNI DR
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City | HILLSBOROUGH
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State | NJ
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Zip | 08844-4528
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Country | US
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Telephone | 908-262-2186
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Fax |
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Provider Business Mailing Address
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Address Line | 115 N 16TH ST
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City | PROSPECT PARK
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State | NJ
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Zip | 07508-1826
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Country | US
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Telephone | 973-931-5840
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0001X
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Taxonomy Name | Radiation Oncology Physician
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License Number | 642755
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 2471R0002X
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Taxonomy Name | Radiation Therapy Radiologic Technologist
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License Number | 642755
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License Number State | NJ
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