Healthcare Provider Details

I. General information

NPI: 1154476570
Provider Name (Legal Business Name): ELAINA BERD-VERGIER D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/24/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 GRAND AVE SUITE 201
ENGLEWOOD NJ
07631-4152
US

IV. Provider business mailing address

420 GRAND AVE SUITE 201
ENGLEWOOD NJ
07631-4152
US

V. Phone/Fax

Practice location:
  • Phone: 201-568-9098
  • Fax: 201-568-9544
Mailing address:
  • Phone: 201-568-9098
  • Fax: 201-568-9544

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License NumberDI 19824
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: