Provider Demographics
NPI:1134125875
Name:TERRY, BERNARD (MD)
Entity Type:Individual
Prefix:
First Name:BERNARD
Middle Name:
Last Name:TERRY
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 1:239 ROUTE 22 EAST
Mailing Address - Street 2:SUITE 302
Mailing Address - City:GREEN BROOK
Mailing Address - State:NJ
Mailing Address - Zip Code:08812
Mailing Address - Country:US
Mailing Address - Phone:732-968-4899
Mailing Address - Fax:732-968-8096
Practice Address - Street 1:3900 PARK AVE
Practice Address - Street 2:STE 107
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08820-3032
Practice Address - Country:US
Practice Address - Phone:732-548-6800
Practice Address - Fax:732-548-6290
Is Sole Proprietor?:No
Enumeration Date:2005-06-27
Last Update Date:2008-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA02814700174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ300102258OtherRAILROAD MEDICARE - SMC
NJ300025891OtherRAILROAD MEDICARE - BRIDGEWATER
NJ1728105Medicaid
NJ300009509OtherRAILROAD MEDICARE - EDISON
NJ300102258OtherRAILROAD MEDICARE - WARREN
NJTE453440Medicare ID - Type Unspecified
NJD18515Medicare UPIN