Healthcare Provider Details

I. General information

NPI: 1356317523
Provider Name (Legal Business Name): SCOTT PHILLIP REED BERK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/27/2006
Last Update Date: 12/16/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33B RUPELL RD
HAMPTON NJ
08827-4017
US

IV. Provider business mailing address

33B RUPELL RD
HAMPTON NJ
08827-4017
US

V. Phone/Fax

Practice location:
  • Phone: 908-238-0077
  • Fax: 908-238-0057
Mailing address:
  • Phone: 908-238-0077
  • Fax: 908-238-0057

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMA06947200
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: