Provider Demographics
NPI:1285684290
Name:BERRIZBEITIA, LUIS DANIEL (MD)
Entity Type:Individual
Prefix:DR
First Name:LUIS
Middle Name:DANIEL
Last Name:BERRIZBEITIA
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 1:78 STOCKTON ST
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:NJ
Mailing Address - Zip Code:08540-6823
Mailing Address - Country:US
Mailing Address - Phone:609-430-8484
Mailing Address - Fax:609-430-9405
Practice Address - Street 1:253 WITHERSPOON ST
Practice Address - Street 2:SUITE F
Practice Address - City:PRINCETON
Practice Address - State:NJ
Practice Address - Zip Code:08540-3211
Practice Address - Country:US
Practice Address - Phone:609-430-8484
Practice Address - Fax:609-430-9405
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-11
Last Update Date:2009-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA05843100208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1809309Medicaid
NJ039003MSSMedicare ID - Type Unspecified
NJ1809309Medicaid