Provider Demographics
NPI:1578867917
Name:MARK BERMAN,MD,PA
Entity Type:Organization
Organization Name:MARK BERMAN,MD,PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORTHOPEDIC SURGEON
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:BERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD,PA
Authorized Official - Phone:201-489-8250
Mailing Address - Street 1:211 ESSEX ST
Mailing Address - Street 2:SUITE 402
Mailing Address - City:HACKENSACK
Mailing Address - State:NJ
Mailing Address - Zip Code:07601-3231
Mailing Address - Country:US
Mailing Address - Phone:201-489-8250
Mailing Address - Fax:201-489-2933
Practice Address - Street 1:211 ESSEX ST
Practice Address - Street 2:SUITE 402
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601-3231
Practice Address - Country:US
Practice Address - Phone:201-489-8250
Practice Address - Fax:201-489-2933
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-28
Last Update Date:2010-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA04662200207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0301809Medicaid
NJA60926Medicare UPIN
NJ409335Medicare PIN