Provider Demographics
NPI:1700816253
Name:BERGER, MARK JAY (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:JAY
Last Name:BERGER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:2 HUDSON PL
Mailing Address - Street 2:FIRST FLOOR
Mailing Address - City:HOBOKEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07030-5594
Mailing Address - Country:US
Mailing Address - Phone:201-418-0040
Mailing Address - Fax:201-418-0903
Practice Address - Street 1:2 HUDSON PL
Practice Address - Street 2:FIRST FLOOR
Practice Address - City:HOBOKEN
Practice Address - State:NJ
Practice Address - Zip Code:07030-5594
Practice Address - Country:US
Practice Address - Phone:201-418-0040
Practice Address - Fax:201-418-0903
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJMA495852085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ5050901Medicaid
NJBE613501Medicare ID - Type Unspecified
NJ5050901Medicaid