Provider Demographics
NPI:1356563340
Name:BERMAN, MARC JASON (DPM)
Entity type:Individual
Prefix:DR
First Name:MARC
Middle Name:JASON
Last Name:BERMAN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:409 COVENTRY DR
Mailing Address - Street 2:
Mailing Address - City:PHILLIPSBURG
Mailing Address - State:NJ
Mailing Address - Zip Code:08865-1969
Mailing Address - Country:US
Mailing Address - Phone:908-213-0029
Mailing Address - Fax:908-213-9393
Practice Address - Street 1:409 COVENTRY DR
Practice Address - Street 2:
Practice Address - City:PHILLIPSBURG
Practice Address - State:NJ
Practice Address - Zip Code:08865-1969
Practice Address - Country:US
Practice Address - Phone:908-213-0029
Practice Address - Fax:908-213-9393
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2013-12-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MD00294800213ES0103X
NYN0062501213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ162446ZCLUMedicare Oscar/Certification