Healthcare Provider Details

I. General information

NPI: 1568400141
Provider Name (Legal Business Name): CHESTNUT RIDGE PEDIATRIC ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

595 CHESTNUT RIDGE RD SUITE 4
WOODCLIFF LAKE NJ
07677-7663
US

IV. Provider business mailing address

595 CHESTNUT RIDGE RD SUITE 4
WOODCLIFF LAKE NJ
07677-7663
US

V. Phone/Fax

Practice location:
  • Phone: 201-391-2020
  • Fax: 201-391-0265
Mailing address:
  • Phone: 201-391-2020
  • Fax: 201-391-0265

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. IRWIN BERKOWITZ
Title or Position: PRESIDENT
Credential: MD
Phone: 201-391-2020