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NPI Code Detail

MEDICARE: DR. JEAN BERGHAUS M.D.

MEDICARE: DR. JEAN BERGHAUS M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1208000000XPediatrics Physician25MA070633NJ

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1457410888
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JEAN BERGHAUS M.D.
Provider Business Mailing Address
First Line : 1771 MADISON AVE
Second Line :
City : LAKEWOOD
State : NJ
Zip : 08701-1251
Country : US
Telephone Number : 732-364-2144
Fax Number : 732-364-3559
Provider Business Practice Location Address
First Line : 1771 MADISON AVE
Second Line :
City : LAKEWOOD
State : NJ
Zip : 08701-1251
Country : US
Telephone Number : 732-364-2144
Fax Number : 732-364-3559
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/08/2006
Last Update Date : 12/14/2012

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