Provider Demographics
NPI:1881815694
Name:BERGE, THOMAS MICHAEL (APN-C)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:MICHAEL
Last Name:BERGE
Suffix:
Gender:M
Credentials:APN-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:403 BETHEL RD
Mailing Address - Street 2:
Mailing Address - City:SOMERS POINT
Mailing Address - State:NJ
Mailing Address - Zip Code:08244-2108
Mailing Address - Country:US
Mailing Address - Phone:609-927-8746
Mailing Address - Fax:609-601-1406
Practice Address - Street 1:330 WEST FRONT STREET
Practice Address - Street 2:ELMER FAMILY PRACTICE
Practice Address - City:ELMER
Practice Address - State:NJ
Practice Address - Zip Code:08318-2143
Practice Address - Country:US
Practice Address - Phone:856-358-0770
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2015-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024167356363LF0000X
NJ26NJ00048300363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ126645SBVMedicare PIN