Provider Demographics
NPI:1659348381
Name:BERMAN, MARK S (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:S
Last Name:BERMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:920 MAIN ST
Mailing Address - Street 2:2ND FLR
Mailing Address - City:HACKENSACK
Mailing Address - State:NJ
Mailing Address - Zip Code:07601-5017
Mailing Address - Country:US
Mailing Address - Phone:201-489-8250
Mailing Address - Fax:201-489-2933
Practice Address - Street 1:920 MAIN ST
Practice Address - Street 2:2ND FLR
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601-5017
Practice Address - Country:US
Practice Address - Phone:201-489-8250
Practice Address - Fax:201-489-2933
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-01
Last Update Date:2013-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA046622174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1578867917OtherMEDICARE NPI
A60926Medicare UPIN
NJBE409335Medicare ID - Type UnspecifiedMEDICARE NUMBER