Provider Demographics
NPI:1245244987
Name:BERARDI, RICHARD (DO)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:
Last Name:BERARDI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:47 MAPLE ST
Mailing Address - Street 2:
Mailing Address - City:SUMMIT
Mailing Address - State:NJ
Mailing Address - Zip Code:07901-2571
Mailing Address - Country:US
Mailing Address - Phone:908-522-5566
Mailing Address - Fax:908-522-1113
Practice Address - Street 1:47 MAPLE ST
Practice Address - Street 2:
Practice Address - City:SUMMIT
Practice Address - State:NJ
Practice Address - Zip Code:07901-2571
Practice Address - Country:US
Practice Address - Phone:908-522-5566
Practice Address - Fax:908-522-1113
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-28
Last Update Date:2019-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY187053207R00000X
NJ25MB05712600207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJF79635Medicare UPIN