Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207YX0905X | Otolaryngology/Facial Plastic Surgery | 147286 | NY |
Y | 207YX0905X | Otolaryngology/Facial Plastic Surgery | 47806 | NJ |
NPI | 1639272289 |
---|---|
Provider Name | Dr. Howard Martin Berg |
First Address | West Orange, NJ 07052 |
Second Address | West Orange, NJ 07052 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/09/2006 |
Last Update Date | 22/12/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0313700 | (05) | NJ |
A63782 | (02) |