Provider Demographics
NPI:1013088095
Name:BERLIN, ROSS (MD)
Entity Type:Individual
Prefix:DR
First Name:ROSS
Middle Name:
Last Name:BERLIN
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 1:125 KENSINGTON DR
Mailing Address - Street 2:
Mailing Address - City:GALLOWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:08205-4678
Mailing Address - Country:US
Mailing Address - Phone:609-748-5380
Mailing Address - Fax:609-652-8749
Practice Address - Street 1:61 W. JIMMIE LEEDS ROAD
Practice Address - Street 2:
Practice Address - City:POMONA
Practice Address - State:NJ
Practice Address - Zip Code:08240-0723
Practice Address - Country:US
Practice Address - Phone:609-748-5380
Practice Address - Fax:609-652-8749
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-13
Last Update Date:2020-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA62121208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6614507Medicaid
NJ792262Medicare PIN
NJ6614507Medicaid