Healthcare Provider Details

I. General information

NPI: 1083184493
Provider Name (Legal Business Name): MIRIAM BERGER RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/28/2018
Last Update Date: 08/26/2023
Certification Date: 08/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 GOLDERS GREEN RD
LAKEWOOD NJ
08701-7551
US

IV. Provider business mailing address

10 GOLDERS GREEN RD
LAKEWOOD NJ
08701-7551
US

V. Phone/Fax

Practice location:
  • Phone: 347-661-1416
  • Fax:
Mailing address:
  • Phone: 347-661-1416
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number26NR20106400
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number25ME00084101
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: