Provider Demographics
NPI:1578785838
Name:BERI, GAGAN DEEP (MD)
Entity Type:Individual
Prefix:DR
First Name:GAGAN
Middle Name:DEEP
Last Name:BERI
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 1:15 FREEMAN ST
Mailing Address - Street 2:
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08820-3922
Mailing Address - Country:US
Mailing Address - Phone:610-470-5590
Mailing Address - Fax:
Practice Address - Street 1:3200 SUNSET AVE
Practice Address - Street 2:SUITE 208
Practice Address - City:OCEAN
Practice Address - State:NJ
Practice Address - Zip Code:07712-4567
Practice Address - Country:US
Practice Address - Phone:732-775-9000
Practice Address - Fax:732-775-6660
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2012-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08202100207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ119251CMMMedicare PIN