Healthcare Provider Details

I. General information

NPI: 1548364169
Provider Name (Legal Business Name): MICHAEL JAMES BERCIK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/12/2006
Last Update Date: 07/25/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

711 WESTMINSTER AVE
ELIZABETH NJ
07208-2210
US

IV. Provider business mailing address

711 WESTMINSTER AVE
ELIZABETH NJ
07208-2210
US

V. Phone/Fax

Practice location:
  • Phone: 908-353-0353
  • Fax: 908-353-0365
Mailing address:
  • Phone: 908-353-0353
  • Fax: 908-353-0365

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number25MA03426400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: