Healthcare Provider Details

I. General information

NPI: 1992029110
Provider Name (Legal Business Name): MELISSA GAIL BERLIN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MELISSA GAIL RAPOPORT

II. Dates (important events)

Enumeration Date: 03/17/2010
Last Update Date: 07/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

230 SHERMAN AVE
GLEN RIDGE NJ
07028-1529
US

IV. Provider business mailing address

14-23 RIVER RD
FAIR LAWN NJ
07410-1240
US

V. Phone/Fax

Practice location:
  • Phone: 973-743-2321
  • Fax: 973-259-0600
Mailing address:
  • Phone: 201-703-0600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number25MA09094700
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: