Provider Demographics
NPI:1477620136
Name:CENTER FOR AESTHETIC AND INTERGRATIVE MEDICINE
Entity type:Organization
Organization Name:CENTER FOR AESTHETIC AND INTERGRATIVE MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:VLADIMIR
Authorized Official - Middle Name:
Authorized Official - Last Name:BERKOVICH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-292-2101
Mailing Address - Street 1:946 LAKEHURST AVE
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:NJ
Mailing Address - Zip Code:08527-0248
Mailing Address - Country:US
Mailing Address - Phone:732-323-8466
Mailing Address - Fax:
Practice Address - Street 1:1707 ATLANTIC AVE BLVD
Practice Address - Street 2:
Practice Address - City:MANASQUAN
Practice Address - State:NJ
Practice Address - Zip Code:08736
Practice Address - Country:US
Practice Address - Phone:732-292-2101
Practice Address - Fax:732-292-2105
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty