Provider Demographics
NPI:1871594655
Name:PEREL, ELLIOTT M (DPM, FACFAS)
Entity type:Individual
Prefix:DR
First Name:ELLIOTT
Middle Name:M
Last Name:PEREL
Suffix:
Gender:M
Credentials:DPM, FACFAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:241 FORSGATE DR
Mailing Address - Street 2:SUITE 206
Mailing Address - City:JAMESBURG
Mailing Address - State:NJ
Mailing Address - Zip Code:08831
Mailing Address - Country:US
Mailing Address - Phone:732-521-2155
Mailing Address - Fax:732-521-1687
Practice Address - Street 1:241 FORSGATE DR STE 206
Practice Address - Street 2:
Practice Address - City:JAMESBURG
Practice Address - State:NJ
Practice Address - Zip Code:08831-1385
Practice Address - Country:US
Practice Address - Phone:732-521-2155
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-03
Last Update Date:2018-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMD002235213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJPE084941Medicare ID - Type Unspecified
NJU41941Medicare UPIN