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General NPI Number Information
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NPI Number | 1053357574
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Entity Type | Organization
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Legal Business Name | BURGESS L. BERLIN, M.D., P.A.
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Dates
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Enumeration Date | 06/22/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 125 PROSPECT ST
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City | SOUTH ORANGE
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State | NJ
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Zip | 07079-1801
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Country | US
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Telephone | 973-761-7755
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Fax | 973-761-6290
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Provider Business Mailing Address
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Address Line | 125 PROSPECT ST
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City | SOUTH ORANGE
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State | NJ
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Zip | 07079-1801
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Country | US
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Telephone | 973-761-7755
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Fax | 973-761-6290
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Authorized Official
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Title or Position | PRESIDENT
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Name | BURGESS L. BERLIN
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Credential |
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Telephone | 973-761-7755
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | MA30653
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License Number State | NJ
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