Provider Demographics
NPI:1134183676
Name:LAWRENCE J BERMAN MD LLC
Entity type:Organization
Organization Name:LAWRENCE J BERMAN MD LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:ELLIOT
Authorized Official - Last Name:WERTENTEIL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-703-0202
Mailing Address - Street 1:20-20 FAIR LAWN AVE
Mailing Address - Street 2:
Mailing Address - City:FAIR LAWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07410-2319
Mailing Address - Country:US
Mailing Address - Phone:201-703-0202
Mailing Address - Fax:201-703-1231
Practice Address - Street 1:20-20 FAIR LAWN AVE
Practice Address - Street 2:
Practice Address - City:FAIR LAWN
Practice Address - State:NJ
Practice Address - Zip Code:07410-2319
Practice Address - Country:US
Practice Address - Phone:201-703-0202
Practice Address - Fax:201-703-1231
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-13
Last Update Date:2008-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8051208Medicaid
NJ087980OtherAETNA
NJ8051208Medicaid
032887Medicare PIN