MEDICARE: CLAYTON FOSTER PERRY MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program
2	207X00000X	Orthopaedic Surgery Physician	25MA12593000	NJ

General Provider Information

NPI Number	:	1356804959
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CLAYTON FOSTER PERRY MD

Provider Business Mailing Address
First Line	:	414 GRAND ST STE 14
Second Line	:
City	:	JERSEY CITY
State	:	NJ
Zip	:	07302-4240
Country	:	US
Telephone Number	:	201-616-7389
Fax Number	:	201-984-2238

Provider Business Practice Location Address
First Line	:	414 GRAND ST STE 14
Second Line	:
City	:	JERSEY CITY
State	:	NJ
Zip	:	07302-4240
Country	:	US
Telephone Number	:	201-616-7389
Fax Number	:	201-984-2238

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/10/2019
Last Update Date	:	05/15/2025

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