MEDICARE: DR. JODI LIEBMAN BERG MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	MD422801	PA
2	208000000X	Pediatrics Physician	25MA08693300	NJ

General Provider Information

NPI Number	:	1225032683
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JODI LIEBMAN BERG MD

Provider Business Mailing Address
First Line	:	20 STOCKTON DR
Second Line	:
City	:	VOORHEES
State	:	NJ
Zip	:	08043-3940
Country	:	US
Telephone Number	:	267-738-1572
Fax Number	:	267-426-6313

Provider Business Practice Location Address
First Line	:	2006 SALEM RD
Second Line	:
City	:	BURLINGTON
State	:	NJ
Zip	:	08016-2204
Country	:	US
Telephone Number	:	609-877-1500
Fax Number	:	609-877-4262

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/13/2005
Last Update Date	:	03/16/2016

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