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NPI Code Detail

MEDICARE: DR. CHARLES JEROME PERRUZZI JR. DMD

MEDICARE: DR. CHARLES JEROME PERRUZZI JR. DMD
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
11223G0001XGeneral Practice DentistryD19224NJ

General Provider Information

NPI Number : 1588751580
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. CHARLES JEROME PERRUZZI JR. DMD
Provider Business Mailing Address
First Line : 88 W RIDGEWOOD AVE
Second Line :
City : RIDGEWOOD
State : NJ
Zip : 07450-3199
Country : US
Telephone Number : 201-652-8875
Fax Number : 201-652-3333
Provider Business Practice Location Address
First Line : 88 W RIDGEWOOD AVE
Second Line :
City : RIDGEWOOD
State : NJ
Zip : 07450-3199
Country : US
Telephone Number : 201-652-8875
Fax Number : 201-652-3333
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/10/2006
Last Update Date : 07/08/2007

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