Provider Demographics
NPI:1023146537
Name:PEEREBOOM, ERIKA A (PA)
Entity type:Individual
Prefix:
First Name:ERIKA
Middle Name:A
Last Name:PEEREBOOM
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 GREEN POND RD
Mailing Address - Street 2:
Mailing Address - City:ROCKAWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:07866-2013
Mailing Address - Country:US
Mailing Address - Phone:973-586-7447
Mailing Address - Fax:973-586-7445
Practice Address - Street 1:35 GREEN POND RD
Practice Address - Street 2:
Practice Address - City:ROCKAWAY
Practice Address - State:NJ
Practice Address - Zip Code:07866-2013
Practice Address - Country:US
Practice Address - Phone:973-586-7447
Practice Address - Fax:973-586-7445
Is Sole Proprietor?:No
Enumeration Date:2007-02-28
Last Update Date:2007-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MP00128700363A00000X, 363AM0700X, 363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
087109Medicare PIN