Healthcare Provider Details

I. General information

NPI: 1053110593
Provider Name (Legal Business Name): JOSHUA D BERGER PMHNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/10/2025
Last Update Date: 03/10/2025
Certification Date: 03/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

635 DUQUESNE BLVD STE 3
BRICK NJ
08723-5073
US

IV. Provider business mailing address

1117 ROBIN DR
LAKEWOOD NJ
08701-3069
US

V. Phone/Fax

Practice location:
  • Phone: 646-907-9480
  • Fax:
Mailing address:
  • Phone: 718-360-6373
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SP0808X
TaxonomyPsychiatric/Mental Health Clinical Nurse Specialist
License Number26NJ15281900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: