Provider Demographics
NPI:1891950796
Name:GLEN W. BERGER, M.D., P.A.
Entity Type:Organization
Organization Name:GLEN W. BERGER, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GLEN
Authorized Official - Middle Name:W
Authorized Official - Last Name:BERGER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-444-9405
Mailing Address - Street 1:110 WARREN AVE
Mailing Address - Street 2:SUITE 5
Mailing Address - City:HO HO KUS
Mailing Address - State:NJ
Mailing Address - Zip Code:07423-1566
Mailing Address - Country:US
Mailing Address - Phone:201-444-9405
Mailing Address - Fax:201-444-9408
Practice Address - Street 1:110 WARREN AVE
Practice Address - Street 2:SUITE 5
Practice Address - City:HO HO KUS
Practice Address - State:NJ
Practice Address - Zip Code:07423-1566
Practice Address - Country:US
Practice Address - Phone:201-444-9405
Practice Address - Fax:201-444-9408
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-21
Last Update Date:2012-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06271300207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty