Provider Demographics
NPI:1346597200
Name:BERBERIAN, DEREK (MD)
Entity Type:Individual
Prefix:DR
First Name:DEREK
Middle Name:
Last Name:BERBERIAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:DEREK
Other - Middle Name:
Other - Last Name:BERBERIAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:227 DONNY BROOK DR
Mailing Address - Street 2:
Mailing Address - City:ALLENDALE
Mailing Address - State:NJ
Mailing Address - Zip Code:07401-1422
Mailing Address - Country:US
Mailing Address - Phone:201-819-8545
Mailing Address - Fax:805-473-5931
Practice Address - Street 1:46 N CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:RAMSEY
Practice Address - State:NJ
Practice Address - Zip Code:07446-1864
Practice Address - Country:US
Practice Address - Phone:201-588-3491
Practice Address - Fax:201-357-4222
Is Sole Proprietor?:No
Enumeration Date:2012-08-10
Last Update Date:2023-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA096556002084P0800X, 202C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes202C00000XAllopathic & Osteopathic PhysiciansIndependent Medical Examiner
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ25MA09655600OtherNJ DIVISION OF CONSUMER AFFAIRS