Provider Demographics
NPI:1548391832
Name:BERI, KAVITA (MD)
Entity Type:Individual
Prefix:
First Name:KAVITA
Middle Name:
Last Name:BERI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3200 SUNSET AVE STE 107
Mailing Address - Street 2:
Mailing Address - City:OCEAN
Mailing Address - State:NJ
Mailing Address - Zip Code:07712-4556
Mailing Address - Country:US
Mailing Address - Phone:732-455-8118
Mailing Address - Fax:732-455-8120
Practice Address - Street 1:2130 HIGHWAY 35 STE 213B
Practice Address - Street 2:
Practice Address - City:SEA GIRT
Practice Address - State:NJ
Practice Address - Zip Code:08750-1011
Practice Address - Country:US
Practice Address - Phone:732-974-8668
Practice Address - Fax:732-974-1078
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-08
Last Update Date:2021-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
282N00000X
NJ25MA08299300207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No282N00000XHospitalsGeneral Acute Care Hospital