Provider Demographics
NPI:1598749020
Name:BERTHA, NICHOLAS A (DO)
Entity Type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:A
Last Name:BERTHA
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:83 HANOVER RD STE 190
Mailing Address - Street 2:ADVANCED LAPAROSCOPIC SURGEONS OF MORRIS
Mailing Address - City:FLORHAM PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07932
Mailing Address - Country:US
Mailing Address - Phone:973-410-9700
Mailing Address - Fax:973-410-9703
Practice Address - Street 1:83 HANOVER RD STE 190
Practice Address - Street 2:ADVANCED LAPAROSCOPIC SURGEONS OF MORRIS
Practice Address - City:FLORHAM PARK
Practice Address - State:NJ
Practice Address - Zip Code:07932
Practice Address - Country:US
Practice Address - Phone:973-410-9700
Practice Address - Fax:973-410-9703
Is Sole Proprietor?:No
Enumeration Date:2005-11-29
Last Update Date:2009-02-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJMB57191208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6493501Medicaid
G24004Medicare UPIN
NJ6493501Medicaid