Provider Demographics
NPI:1689927105
Name:SHELLEY BERSON MD, PC
Entity Type:Organization
Organization Name:SHELLEY BERSON MD, PC
Other - Org Name:ZZENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SHELLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:BERSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-391-8282
Mailing Address - Street 1:305 W GRAND AVE
Mailing Address - Street 2:SUITE 500
Mailing Address - City:MONTVALE
Mailing Address - State:NJ
Mailing Address - Zip Code:07645-1813
Mailing Address - Country:US
Mailing Address - Phone:201-391-8282
Mailing Address - Fax:201-391-8299
Practice Address - Street 1:305 W GRAND AVE
Practice Address - Street 2:SUITE 500
Practice Address - City:MONTVALE
Practice Address - State:NJ
Practice Address - Zip Code:07645-1813
Practice Address - Country:US
Practice Address - Phone:201-391-8282
Practice Address - Fax:201-391-8299
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-22
Last Update Date:2012-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA05783000207YS0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207YS0012XAllopathic & Osteopathic PhysiciansOtolaryngologySleep MedicineGroup - Single Specialty