=====================================================
General NPI Number Information
=====================================================
NPI Number | 1346620390
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BERLIN MEDICAL ASSOCIATES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/04/2015
-----------------------------------------------------
Last Update Date | 06/04/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 175 CROSS KEYS RD STE 300B
-----------------------------------------------------
City | BERLIN
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08009-9263
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 856-753-7335
-----------------------------------------------------
Fax | 856-306-6590
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 175 CROSS KEYS RD STE 300B
-----------------------------------------------------
City | BERLIN
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08009-9263
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 856-753-7335
-----------------------------------------------------
Fax | 856-306-6590
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CHIEF MEDICAL OFFICER
-----------------------------------------------------
Name | DR. DAVID HASSMAN
-----------------------------------------------------
Credential | D.O.
-----------------------------------------------------
Telephone | 856-753-7335
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363A00000X
-----------------------------------------------------
Taxonomy Name | Physician Assistant
-----------------------------------------------------
License Number | 25MP00080500
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------