Provider Demographics
NPI:1356317523
Name:BERK, SCOTT PHILLIP REED (MD)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:PHILLIP REED
Last Name:BERK
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 1:33B RUPELL RD
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08827-4017
Mailing Address - Country:US
Mailing Address - Phone:908-238-0077
Mailing Address - Fax:908-238-0057
Practice Address - Street 1:33B RUPELL RD
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:NJ
Practice Address - Zip Code:08827-4017
Practice Address - Country:US
Practice Address - Phone:908-238-0077
Practice Address - Fax:908-238-0057
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-27
Last Update Date:2013-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA06947200207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
H01338Medicare UPIN
029878C3YMedicare ID - Type Unspecified
NJ0078476Medicare ID - Type Unspecified