Provider Demographics
NPI:1225032683
Name:BERG, JODI LIEBMAN (MD)
Entity Type:Individual
Prefix:DR
First Name:JODI
Middle Name:LIEBMAN
Last Name:BERG
Suffix:
Gender:F
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 STOCKTON DR
Mailing Address - Street 2:
Mailing Address - City:VOORHEES
Mailing Address - State:NJ
Mailing Address - Zip Code:08043-3940
Mailing Address - Country:US
Mailing Address - Phone:267-738-1572
Mailing Address - Fax:267-426-6313
Practice Address - Street 1:2006 SALEM RD
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:NJ
Practice Address - Zip Code:08016-2204
Practice Address - Country:US
Practice Address - Phone:609-877-1500
Practice Address - Fax:609-877-4262
Is Sole Proprietor?:No
Enumeration Date:2005-06-13
Last Update Date:2016-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD422801208000000X
NJ25MA08693300208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
077356 SK3Medicare PIN
086733Medicare UPIN