Healthcare Provider Details

I. General information

NPI: 1124002779
Provider Name (Legal Business Name): BERLIN FAMILY PRACTICE ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/06/2005
Last Update Date: 02/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23 HARKER AVE
BERLIN NJ
08009
US

IV. Provider business mailing address

23 HARKER AVE
BERLIN NJ
08009
US

V. Phone/Fax

Practice location:
  • Phone: 856-767-0078
  • Fax: 856-767-3662
Mailing address:
  • Phone: 856-767-0078
  • Fax: 856-767-3662

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License NumberMB064541
License Number StateNJ

VIII. Authorized Official

Name: DR. JOHN A LARATTA
Title or Position: PRESIDENT
Credential: DO
Phone: 856-767-0078