Provider Demographics
NPI:1487736294
Name:PERRY, JR., DAVID (PA-C)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:
Last Name:PERRY, JR.
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 ROUTE 109
Mailing Address - Street 2:
Mailing Address - City:CAPE MAY
Mailing Address - State:NJ
Mailing Address - Zip Code:08204-5259
Mailing Address - Country:US
Mailing Address - Phone:609-884-4357
Mailing Address - Fax:
Practice Address - Street 1:1500 ALPS RD
Practice Address - Street 2:
Practice Address - City:WAYNE
Practice Address - State:NJ
Practice Address - Zip Code:07470-3635
Practice Address - Country:US
Practice Address - Phone:973-628-8500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MP00162900363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ25MP00162900OtherLICENSE NUMBER