Provider Demographics
NPI:1730399866
Name:PERRELLA, GERARD R (DC)
Entity type:Individual
Prefix:DR
First Name:GERARD
Middle Name:R
Last Name:PERRELLA
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 SANTIAGO DR W
Mailing Address - Street 2:
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08757-6403
Mailing Address - Country:US
Mailing Address - Phone:732-552-9693
Mailing Address - Fax:
Practice Address - Street 1:22 SANTIAGO DR W
Practice Address - Street 2:
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08757-6403
Practice Address - Country:US
Practice Address - Phone:732-552-9693
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-24
Last Update Date:2012-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00604500111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor