Provider Demographics
NPI:1184691594
Name:BERLET, ANTHONY CLAYTON (MD)
Entity type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:CLAYTON
Last Name:BERLET
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:15 ASPEN DR
Mailing Address - Street 2:
Mailing Address - City:NORTH CALDWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:07006-4555
Mailing Address - Country:US
Mailing Address - Phone:973-618-0259
Mailing Address - Fax:973-857-7757
Practice Address - Street 1:908 POMPTON AVE
Practice Address - Street 2:SUITE A-1
Practice Address - City:CEDAR GROVE
Practice Address - State:NJ
Practice Address - Zip Code:07009-1253
Practice Address - Country:US
Practice Address - Phone:973-857-7757
Practice Address - Fax:973-857-7758
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA056242002086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJF53463Medicare UPIN