Provider Demographics
NPI:1912553298
Name:BERENBERG, SAMUEL BRENTWOOD
Entity Type:Individual
Prefix:
First Name:SAMUEL
Middle Name:BRENTWOOD
Last Name:BERENBERG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 SEWARD DR
Mailing Address - Street 2:
Mailing Address - City:OCEAN
Mailing Address - State:NJ
Mailing Address - Zip Code:07712-3724
Mailing Address - Country:US
Mailing Address - Phone:908-675-5771
Mailing Address - Fax:
Practice Address - Street 1:3 SEWARD DR
Practice Address - Street 2:
Practice Address - City:OCEAN
Practice Address - State:NJ
Practice Address - Zip Code:07712-3724
Practice Address - Country:US
Practice Address - Phone:908-675-5771
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-13
Last Update Date:2019-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer