Provider Demographics
NPI:1841285780
Name:BERDUGO, CLAUDIA E (DO)
Entity type:Individual
Prefix:DR
First Name:CLAUDIA
Middle Name:E
Last Name:BERDUGO
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 SUMMER AVE
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07104-2628
Mailing Address - Country:US
Mailing Address - Phone:973-484-2800
Mailing Address - Fax:973-484-9633
Practice Address - Street 1:205 SUMMER AVE
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07104-2628
Practice Address - Country:US
Practice Address - Phone:973-484-2800
Practice Address - Fax:973-484-9633
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-16
Last Update Date:2013-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB06428000207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7944608Medicaid
NJ028783PD0Medicare PIN
NJG98242Medicare UPIN
NJ6452110001Medicare NSC