Provider Demographics
NPI:1629499314
Name:NJ INDEPENDENT INTERNAL MEDICINE
Entity Type:Organization
Organization Name:NJ INDEPENDENT INTERNAL MEDICINE
Other - Org Name:BERKELMD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:REYHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BERKEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:517-303-3120
Mailing Address - Street 1:1300 MAIN AVE
Mailing Address - Street 2:2A
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07011-2266
Mailing Address - Country:US
Mailing Address - Phone:973-340-0160
Mailing Address - Fax:201-270-5112
Practice Address - Street 1:1300 MAIN AVE
Practice Address - Street 2:2A
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07011-2266
Practice Address - Country:US
Practice Address - Phone:973-340-0160
Practice Address - Fax:201-270-5112
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-23
Last Update Date:2013-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08709600261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care