Provider Demographics
NPI:1639272289
Name:BERG, HOWARD MARTIN (MD)
Entity Type:Individual
Prefix:DR
First Name:HOWARD
Middle Name:MARTIN
Last Name:BERG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:101 OLD SHORT HILLS ROAD
Mailing Address - Street 2:SUITE 520
Mailing Address - City:WEST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07052
Mailing Address - Country:US
Mailing Address - Phone:973-731-5400
Mailing Address - Fax:973-669-0805
Practice Address - Street 1:101 OLD SHORT HILLS ROAD
Practice Address - Street 2:SUITE 520
Practice Address - City:WEST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07052
Practice Address - Country:US
Practice Address - Phone:973-731-5400
Practice Address - Fax:973-669-0805
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2011-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ47806207YX0905X
NY147286207YX0905X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YX0905XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngology/Facial Plastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0313700Medicaid
044042Medicare ID - Type Unspecified
NJ0313700Medicaid