Provider Demographics
NPI:1316375074
Name:SHELLEY BERSON MD PC
Entity Type:Organization
Organization Name:SHELLEY BERSON MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MAGGIE
Authorized Official - Middle Name:
Authorized Official - Last Name:CUELLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-391-8282
Mailing Address - Street 1:305 W GRAND AVE
Mailing Address - Street 2:SUITE 500
Mailing Address - City:MONTVALE
Mailing Address - State:NJ
Mailing Address - Zip Code:07645-1813
Mailing Address - Country:US
Mailing Address - Phone:201-391-8282
Mailing Address - Fax:201-391-8299
Practice Address - Street 1:305 W GRAND AVE
Practice Address - Street 2:SUITE 500
Practice Address - City:MONTVALE
Practice Address - State:NJ
Practice Address - Zip Code:07645-1813
Practice Address - Country:US
Practice Address - Phone:201-391-8282
Practice Address - Fax:201-391-8299
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-16
Last Update Date:2013-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA05783000173F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes173F00000XOther Service ProvidersSleep Specialist, PhDGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1689927105OtherINDIVIDUAL NPI