Provider Demographics
NPI:1740254291
Name:BERLIN, JENNIFER MICHELE (DPM)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:MICHELE
Last Name:BERLIN
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 JEFFERSON CT
Mailing Address - Street 2:
Mailing Address - City:MONROE TOWNSHIP
Mailing Address - State:NJ
Mailing Address - Zip Code:08831-5108
Mailing Address - Country:US
Mailing Address - Phone:267-229-4366
Mailing Address - Fax:
Practice Address - Street 1:17 WHITE HORSE PIKE
Practice Address - Street 2:SUITE 10A
Practice Address - City:HADDON HEIGHTS
Practice Address - State:NJ
Practice Address - Zip Code:08035-1299
Practice Address - Country:US
Practice Address - Phone:856-546-8989
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-13
Last Update Date:2012-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MD00284300213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ25MD00284300OtherSTATE LICENSE
NJ092632Medicare ID - Type Unspecified
NJ25MD00284300OtherSTATE LICENSE