Healthcare Provider Details

I. General information

NPI: 1669654372
Provider Name (Legal Business Name): SAMARTH BERI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/04/2007
Last Update Date: 04/13/2020
Certification Date: 04/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 ENGLE ST
ENGLEWOOD NJ
07631-1898
US

IV. Provider business mailing address

88 ALPINE CT
DEMAREST NJ
07627-2313
US

V. Phone/Fax

Practice location:
  • Phone: 201-894-3238
  • Fax:
Mailing address:
  • Phone: 917-535-3445
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number25MA09614700
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number249099
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: