Provider Demographics
NPI:1366539769
Name:PERTSEMLIDIS, DAVID STEPHEN (MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:STEPHEN
Last Name:PERTSEMLIDIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 416457
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02241-6457
Mailing Address - Country:US
Mailing Address - Phone:973-971-4179
Mailing Address - Fax:973-971-7905
Practice Address - Street 1:435 SOUTH ST
Practice Address - Street 2:SUITE 230B
Practice Address - City:MORRISTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07960-6422
Practice Address - Country:US
Practice Address - Phone:973-267-2838
Practice Address - Fax:973-267-7909
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2014-05-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY207798208600000X
NJ25MA09424600208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
29B921Medicare ID - Type Unspecified
H35661Medicare UPIN