Provider Demographics
NPI:1538145446
Name:BERGER, EDWARD H (PHD)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:H
Last Name:BERGER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:521 RUTLAND AVE
Mailing Address - Street 2:
Mailing Address - City:TEANECK
Mailing Address - State:NJ
Mailing Address - Zip Code:07666-2925
Mailing Address - Country:US
Mailing Address - Phone:201-837-8573
Mailing Address - Fax:201-837-8573
Practice Address - Street 1:521 RUTLAND AVE
Practice Address - Street 2:
Practice Address - City:TEANECK
Practice Address - State:NJ
Practice Address - Zip Code:07666-2925
Practice Address - Country:US
Practice Address - Phone:201-837-8573
Practice Address - Fax:201-837-8573
Is Sole Proprietor?:No
Enumeration Date:2005-12-22
Last Update Date:2007-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35SI00010400103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ699675Medicare PIN