Provider Demographics
NPI:1982676722
Name:BERMUDEZ, JUAN DAVID (MD)
Entity Type:Individual
Prefix:DR
First Name:JUAN
Middle Name:DAVID
Last Name:BERMUDEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 HOOPER AVENUE
Mailing Address - Street 2:
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08753
Mailing Address - Country:US
Mailing Address - Phone:732-797-3890
Mailing Address - Fax:732-797-3893
Practice Address - Street 1:54 BEY LEA ROAD
Practice Address - Street 2:BLDG 2
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08753
Practice Address - Country:US
Practice Address - Phone:732-281-1020
Practice Address - Fax:732-797-3893
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA055146207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ4012909Medicaid
A64566Medicare UPIN
NJBE615673QW9Medicare ID - Type Unspecified