=====================================================
General NPI Number Information
=====================================================
NPI Number | 1659361079
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BERT MICHAEL BIELER M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/26/2005
-----------------------------------------------------
Last Update Date | 04/02/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1210 BRACE RD
-----------------------------------------------------
City | CHERRY HILL
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08034-3213
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 856-795-3597
-----------------------------------------------------
Fax | 856-783-8537
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1 FEDERAL ST # 200
-----------------------------------------------------
City | CAMDEN
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08103-1088
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 856-356-4924
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RE0101X
-----------------------------------------------------
Taxonomy Name | Endocrinology, Diabetes & Metabolism Physician
-----------------------------------------------------
License Number | 25MA08698100
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------