=====================================================
General NPI Number Information
=====================================================
NPI Number | 1710399985
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ALEXANDER PERELMAN D.O.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/22/2014
-----------------------------------------------------
Last Update Date | 10/27/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 456 PROSPECT AVE FL 2
-----------------------------------------------------
City | WEST ORANGE
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07052-4112
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 862-703-7449
-----------------------------------------------------
Fax | 862-693-4480
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 456 PROSPECT AVE FL 2
-----------------------------------------------------
City | WEST ORANGE
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07052-4112
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 862-703-7449
-----------------------------------------------------
Fax | 862-693-4480
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RG0100X
-----------------------------------------------------
Taxonomy Name | Gastroenterology Physician
-----------------------------------------------------
License Number | 25MB12703400
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------