NPIMap

Organization Active NPI

Perry Medical Group of New Jersey PA

  • General Practice Physician
  • New York, NY
National Provider Identifier
1114595592
Registry record updated Jun 30, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice PhysicianTaxonomy code 208D00000X
Legal business name
PERRY MEDICAL GROUP OF NEW JERSEY PA
Practice address
169 Madison Ave Ste 90030
New York, NY 10016-5101
Phone
(978) 850-3914
Fax
(646) 365-0517
NPI assigned
Jun 14, 2021
Last updated
Jun 30, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 30, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Jennifer Harless
Title
Director, RCM
Phone
(508) 494-8275

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Physician 208D00000X NU Primary

Addresses

Primary practice location

169 Madison Ave Ste 90030
New York, NY 10016-5101

Mailing address

169 Madison Ave Ste 90030
New York, NY 10016-5101
Phone (978) 850-3914

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY, NJ, IL, PA, TX, HI, MA7 enrollments

Enrollment records 7

Enrollment IDStateProvider typePAC IDDetails
O20221024001343 NY Part B Supplier - Clinic/Group Practice 0648646240 Receives reassigned benefits from 1 practitioner
Practice locations: Tuxedo Park, NY; New York, NY
O20231129001537 NJ Part B Supplier - Clinic/Group Practice 0648646240 Receives reassigned benefits from 1 practitioner
Practice locations: Medford, NJ
O20240207001251 IL Part B Supplier - Clinic/Group Practice 0648646240 Receives reassigned benefits from 1 practitioner
Practice locations: Geneva, IL; Chicago, IL
O20240419001899 PA Part B Supplier - Clinic/Group Practice 0648646240 Receives reassigned benefits from 1 practitioner
Practice locations: Schwenksville, PA
O20240514000851 TX Part B Supplier - Clinic/Group Practice 0648646240 Receives reassigned benefits from 2 practitioners
Practice locations: Dallas, TX; Katy, TX
O20241011000558 HI Part B Supplier - Clinic/Group Practice 0648646240 Receives reassigned benefits from 1 practitioner
Practice locations: Honolulu, HI
O20250228000420 MA Part B Supplier - Clinic/Group Practice 0648646240 Receives reassigned benefits from 1 practitioner
Practice locations: Beverly, MA

National Provider Directory

National Provider Directory

Locations

150 W 22nd St
Fl 8
New York, NY 10011
Phone (646) 809-4094

215 Park Ave S
Fl 12
New York, NY 10003
Phone (469) 772-9400

Practitioners & affiliated clinicians

Practitioners 10

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1623628800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1782777600000",
    "number": "1114595592",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "169 MADISON AVE STE 90030",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100165101",
            "telephone_number": "978-850-3914",
            "fax_number": "646-365-0517"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "169 MADISON AVE STE 90030",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100165101",
            "telephone_number": "978-850-3914",
            "fax_number": "646-365-0517"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PERRY MEDICAL GROUP OF NEW JERSEY PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-06-14",
        "last_updated": "2026-06-30",
        "certification_date": "2026-06-30",
        "status": "A",
        "authorized_official_last_name": "HARLESS",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_title_or_position": "DIRECTOR, RCM",
        "authorized_official_telephone_number": "508-494-8275"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in New York, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 30, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.