Provider Demographics
NPI:1154476570
Name:BERD-VERGIER, ELAINA (DDS)
Entity Type:Individual
Prefix:DR
First Name:ELAINA
Middle Name:
Last Name:BERD-VERGIER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 GRAND AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:ENGLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07631-4152
Mailing Address - Country:US
Mailing Address - Phone:201-568-9098
Mailing Address - Fax:201-568-9544
Practice Address - Street 1:420 GRAND AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:ENGLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07631-4152
Practice Address - Country:US
Practice Address - Phone:201-568-9098
Practice Address - Fax:201-568-9544
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI 198241223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics