Healthcare Provider Details

I. General information

NPI: 1235745225
Provider Name (Legal Business Name): DENMARI BERBERABE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2020
Last Update Date: 09/16/2020
Certification Date: 09/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6000 JOHN F. KENNEDY BOULEVARD
WEST NEW YORK NJ
07093
US

IV. Provider business mailing address

20 W SOMERSET ST
RARITAN NJ
08869-2001
US

V. Phone/Fax

Practice location:
  • Phone: 201-758-0099
  • Fax:
Mailing address:
  • Phone: 908-698-9863
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number40QA01952300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: