Provider Demographics
NPI:1083673297
Name:BERMAN, LAWRENCE JOSEPH (MD)
Entity Type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:JOSEPH
Last Name:BERMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20-20 FAIR LAWN AVE
Mailing Address - Street 2:
Mailing Address - City:FAIR LAWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07410-2319
Mailing Address - Country:US
Mailing Address - Phone:201-703-0202
Mailing Address - Fax:201-703-1231
Practice Address - Street 1:20-20 FAIR LAWN AVE
Practice Address - Street 2:
Practice Address - City:FAIR LAWN
Practice Address - State:NJ
Practice Address - Zip Code:07410-2319
Practice Address - Country:US
Practice Address - Phone:201-703-0202
Practice Address - Fax:201-703-1231
Is Sole Proprietor?:No
Enumeration Date:2006-03-17
Last Update Date:2008-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA22933207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8051208Medicaid
NJ1083673297OtherNPI
NJPP008OtherOXFORD
NJ0076254000OtherAMERIHEALTH
NJ087980OtherAETNA
40F781OtherEMPIRE
NJ482047OtherUNITEDHEALTHCARE
NJPP008OtherOXFORD
CG1811Medicare PIN