Healthcare Provider Details

I. General information

NPI: 1659348381
Provider Name (Legal Business Name): MARK S BERMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/01/2006
Last Update Date: 02/27/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

920 MAIN ST 2ND FLR
HACKENSACK NJ
07601-5017
US

IV. Provider business mailing address

920 MAIN ST 2ND FLR
HACKENSACK NJ
07601-5017
US

V. Phone/Fax

Practice location:
  • Phone: 201-489-8250
  • Fax: 201-489-2933
Mailing address:
  • Phone: 201-489-8250
  • Fax: 201-489-2933

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberMA046622
License Number StateNJ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier1578867917
Identifier TypeOTHER
Identifier StateNJ
Identifier IssuerMEDICARE NPI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: