Provider Demographics
NPI:1225466824
Name:BEREN, JOSEPH (PA)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:
Last Name:BEREN
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 JAMES ST STE 204
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08701-4101
Mailing Address - Country:US
Mailing Address - Phone:732-363-4003
Mailing Address - Fax:
Practice Address - Street 1:150 JAMES ST STE 204
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08701-4101
Practice Address - Country:US
Practice Address - Phone:732-363-4003
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-10-17
Last Update Date:2013-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MP00320800363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical