Provider Demographics
NPI:1487175923
Name:PERKOFF, JOHN (PHYSICIAN ASSISTANT)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:PERKOFF
Suffix:
Gender:M
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39 WALNUT AVE
Mailing Address - Street 2:
Mailing Address - City:MILLBURN
Mailing Address - State:NJ
Mailing Address - Zip Code:07041-1511
Mailing Address - Country:US
Mailing Address - Phone:973-467-4476
Mailing Address - Fax:
Practice Address - Street 1:200 S ORANGE AVE STE 180
Practice Address - Street 2:
Practice Address - City:LIVINGSTON
Practice Address - State:NJ
Practice Address - Zip Code:07039-5817
Practice Address - Country:US
Practice Address - Phone:973-226-2725
Practice Address - Fax:973-226-3270
Is Sole Proprietor?:No
Enumeration Date:2017-07-06
Last Update Date:2022-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MP00440200363A00000X, 363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant