Provider Demographics
NPI:1528070695
Name:PEREZ, CARMEN (APN)
Entity type:Individual
Prefix:
First Name:CARMEN
Middle Name:
Last Name:PEREZ
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:137 ATLANTIC CITY BLVD
Mailing Address - Street 2:
Mailing Address - City:BEACHWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08722-2935
Mailing Address - Country:US
Mailing Address - Phone:732-244-8666
Mailing Address - Fax:732-244-0046
Practice Address - Street 1:137 ATLANTIC CITY BLVD
Practice Address - Street 2:
Practice Address - City:BEACHWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08722-2935
Practice Address - Country:US
Practice Address - Phone:732-244-8666
Practice Address - Fax:732-244-0046
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-13
Last Update Date:2025-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00017800207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty