Provider Demographics
NPI:1588677207
Name:BERGER, JEFFREY A (PHD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:A
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 1:296 AMBOY AVE.
Mailing Address - Street 2:
Mailing Address - City:METUCHEN
Mailing Address - State:NJ
Mailing Address - Zip Code:08840-2471
Mailing Address - Country:US
Mailing Address - Phone:732-548-2422
Mailing Address - Fax:732-548-0568
Practice Address - Street 1:296 AMBOY AVE
Practice Address - Street 2:
Practice Address - City:METUCHEN
Practice Address - State:NJ
Practice Address - Zip Code:08840-2471
Practice Address - Country:US
Practice Address - Phone:732-548-2422
Practice Address - Fax:732-548-0568
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-14
Last Update Date:2007-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35SI00110500103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ454262Medicare ID - Type UnspecifiedPSYCHOLOGIST