Provider Demographics
NPI:1083700124
Name:BERKMAN, AVRILL ROY (MD)
Entity Type:Individual
Prefix:DR
First Name:AVRILL
Middle Name:ROY
Last Name:BERKMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1140 BLOOMFIELD AVE
Mailing Address - Street 2:SUITE 106
Mailing Address - City:WEST CALDWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:07006-7130
Mailing Address - Country:US
Mailing Address - Phone:973-228-3668
Mailing Address - Fax:973-227-6061
Practice Address - Street 1:1140 BLOOMFIELD AVE
Practice Address - Street 2:SUITE 106
Practice Address - City:WEST CALDWELL
Practice Address - State:NJ
Practice Address - Zip Code:07006-7130
Practice Address - Country:US
Practice Address - Phone:973-228-3668
Practice Address - Fax:973-227-6061
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2010-01-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA04147800207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1655001Medicaid
PS157OtherOXFORD HEALTH PLAN
57K722OtherEMPIRE HEALTH PLAN
OK3089OtherHEALTHNET HEALTH PLAN
NJ1655001Medicaid
57K722OtherEMPIRE HEALTH PLAN