Provider Demographics
NPI:1649397514
Name:JOEL F BERMAN D.P.M.
Entity Type:Organization
Organization Name:JOEL F BERMAN D.P.M.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPPLIER
Authorized Official - Prefix:
Authorized Official - First Name:JOEL
Authorized Official - Middle Name:F
Authorized Official - Last Name:BERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:530-742-0365
Mailing Address - Street 1:812 4TH ST
Mailing Address - Street 2:SUITE D
Mailing Address - City:MARYSVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95901-5667
Mailing Address - Country:US
Mailing Address - Phone:530-742-0365
Mailing Address - Fax:530-742-3338
Practice Address - Street 1:415 ALTURAS ST STE 5
Practice Address - Street 2:
Practice Address - City:YUBA CITY
Practice Address - State:CA
Practice Address - Zip Code:95991-4144
Practice Address - Country:US
Practice Address - Phone:530-742-0365
Practice Address - Fax:530-742-3338
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JOEL F BERMAN D.P.M.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-03-23
Last Update Date:2022-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE3476332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1679554778OtherD-MERC
CA4775130002Medicare NSC
CAT11701Medicare UPIN