Healthcare Provider Details

I. General information

NPI: 1861696106
Provider Name (Legal Business Name): STEPHEN L. BERGER D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/12/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 WASHINGTON ST SUITE 200
EAST ORANGE NJ
07017-1495
US

IV. Provider business mailing address

55 WASHINGTON ST SUITE 200
EAST ORANGE NJ
07017-1495
US

V. Phone/Fax

Practice location:
  • Phone: 973-678-7833
  • Fax: 973-678-7839
Mailing address:
  • Phone: 973-678-7833
  • Fax: 973-678-7839

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number38MC00451300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: