Provider Demographics
NPI:1255883716
Name:BERKOVICH, GADY (APN)
Entity type:Individual
Prefix:
First Name:GADY
Middle Name:
Last Name:BERKOVICH
Suffix:
Gender:M
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 GREENVILLE AVE
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07305-2608
Mailing Address - Country:US
Mailing Address - Phone:201-333-8222
Mailing Address - Fax:201-333-0095
Practice Address - Street 1:26 GREENVILLE AVE
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07305-2608
Practice Address - Country:US
Practice Address - Phone:201-333-8222
Practice Address - Fax:201-333-0095
Is Sole Proprietor?:No
Enumeration Date:2016-11-01
Last Update Date:2024-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00682500363LA2200X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0554057Medicaid
NJ1255883716Medicaid