Provider Demographics
NPI:1205806015
Name:BERKOVICH, VLADIMIR (MD)
Entity type:Individual
Prefix:
First Name:VLADIMIR
Middle Name:
Last Name:BERKOVICH
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 1:2399 ROUTE 34
Mailing Address - Street 2:SUITE A-5
Mailing Address - City:MANASQUAN
Mailing Address - State:NJ
Mailing Address - Zip Code:08736-1500
Mailing Address - Country:US
Mailing Address - Phone:732-528-5533
Mailing Address - Fax:732-528-0360
Practice Address - Street 1:2399 ROUTE 34
Practice Address - Street 2:SUITE A-5
Practice Address - City:WALL TOWNSHIP
Practice Address - State:NJ
Practice Address - Zip Code:08736
Practice Address - Country:US
Practice Address - Phone:732-528-5533
Practice Address - Fax:732-528-0360
Is Sole Proprietor?:No
Enumeration Date:2006-01-24
Last Update Date:2022-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06755800207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJH22918Medicare UPIN