Provider Demographics
NPI:1174611990
Name:PERIOPERATIVE MEDICINE AND ANESTHESIA PC
Entity type:Organization
Organization Name:PERIOPERATIVE MEDICINE AND ANESTHESIA PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PERRY
Authorized Official - Middle Name:A
Authorized Official - Last Name:LOESBERG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:609-599-5097
Mailing Address - Street 1:PO BOX 18739
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07191-8739
Mailing Address - Country:US
Mailing Address - Phone:800-426-1699
Mailing Address - Fax:
Practice Address - Street 1:601 HAMILTON AVE
Practice Address - Street 2:
Practice Address - City:TRENTON
Practice Address - State:NJ
Practice Address - Zip Code:08629-1915
Practice Address - Country:US
Practice Address - Phone:609-599-5097
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-10
Last Update Date:2010-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8167206Medicaid
017277Medicare ID - Type Unspecified