Provider Demographics
NPI:1578673257
Name:PEREZ, VICTORIA P (MD)
Entity type:Individual
Prefix:
First Name:VICTORIA
Middle Name:P
Last Name:PEREZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:VICTORIA
Other - Middle Name:
Other - Last Name:PEREZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:354 OLD HOOK RD
Mailing Address - Street 2:STE 105
Mailing Address - City:WESTWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07675
Mailing Address - Country:US
Mailing Address - Phone:201-666-2035
Mailing Address - Fax:201-666-5612
Practice Address - Street 1:354 OLD HOOK RD
Practice Address - Street 2:STE 105
Practice Address - City:WESTWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07675
Practice Address - Country:US
Practice Address - Phone:201-666-2035
Practice Address - Fax:201-666-5612
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA02967000207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
D19810Medicare UPIN
552030Medicare ID - Type Unspecified