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General NPI Number Information
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NPI Number | 1578867917
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Entity Type | Organization
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Legal Business Name | MARK BERMAN,MD,PA
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Dates
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Enumeration Date | 12/28/2010
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Last Update Date | 12/30/2010
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Provider Practice Location Address
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Address Line | 211 ESSEX ST SUITE 402
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City | HACKENSACK
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State | NJ
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Zip | 07601-3231
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Country | US
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Telephone | 201-489-8250
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Fax | 201-489-2933
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Provider Business Mailing Address
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Address Line | 211 ESSEX ST SUITE 402
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City | HACKENSACK
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State | NJ
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Zip | 07601-3231
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Country | US
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Telephone | 201-489-8250
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Fax | 201-489-2933
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Authorized Official
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Title or Position | ORTHOPEDIC SURGEON
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Name | MARK BERMAN
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Credential | M.D.,P.A.
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Telephone | 201-489-8250
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207XX0005X
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Taxonomy Name | Sports Medicine (Orthopaedic Surgery) Physician
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License Number | 25MA04662200
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License Number State | NJ
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