Healthcare Provider Details

I. General information

NPI: 1831359330
Provider Name (Legal Business Name): EMILY M BERGER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2008
Last Update Date: 09/26/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3550 MARKET ST 2ND FLOOR
PHILADELPHIA PA
19104-3329
US

IV. Provider business mailing address

155 POLIFLY RD SUITE 101
HACKENSACK NJ
07601-1758
US

V. Phone/Fax

Practice location:
  • Phone: 914-441-0582
  • Fax:
Mailing address:
  • Phone: 551-996-8697
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207NP0225X
TaxonomyPediatric Dermatology Physician
License NumberMD4456680
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207NP0225X
TaxonomyPediatric Dermatology Physician
License Number25MA09367700
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code207NP0225X
TaxonomyPediatric Dermatology Physician
License Number257580
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: