=====================================================
General NPI Number Information
=====================================================
NPI Number | 1013044585
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JERSEY SHORE BRACHYTHERAPY P A
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/28/2007
-----------------------------------------------------
Last Update Date | 10/01/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 900 ROUTE 70 WEST
-----------------------------------------------------
City | LAKEWOOD
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08701-5940
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-739-6476
-----------------------------------------------------
Fax | 732-739-2056
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6 REGAL CT
-----------------------------------------------------
City | TOMS RIVER
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08753-5642
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-739-6476
-----------------------------------------------------
Fax | 732-739-2056
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | STEWART A BERKOWITZ
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 732-739-6476
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2085R0001X
-----------------------------------------------------
Taxonomy Name | Radiation Oncology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------