Provider Demographics
NPI:1841264025
Name:KELBERG, BERNARD D (DO)
Entity type:Individual
Prefix:DR
First Name:BERNARD
Middle Name:D
Last Name:KELBERG
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1235 WHITEHORSE MERCERVILLE RD
Mailing Address - Street 2:BLDG C, SUITE 317
Mailing Address - City:HAMILTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08619-3810
Mailing Address - Country:US
Mailing Address - Phone:609-581-5150
Mailing Address - Fax:609-581-5149
Practice Address - Street 1:1235 WHITEHORSE MERCERVILLE RD
Practice Address - Street 2:BLDG C, SUITE 317
Practice Address - City:HAMILTON
Practice Address - State:NJ
Practice Address - Zip Code:08619-3810
Practice Address - Country:US
Practice Address - Phone:609-581-5150
Practice Address - Fax:609-581-5149
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-15
Last Update Date:2008-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB02059300207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2813009Medicaid
NJ459275Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER
NJC53957Medicare UPIN