Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 25MA08660100 | NJ |
Y | 207QG0300X | Family Doctor - Geriatric Medicine | 25MA08660100 | NJ |
N | 207QH0002X | Family Doctor - Hospice and Palliative Medicine | 25MA08660100 | NJ |
NPI | 1124285176 |
---|---|
Provider Name | Dr. Kevin James Berg |
First Address | Verona, NJ 07044-1367 |
Second Address | Verona, NJ 07044-1367 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/05/2008 |
Last Update Date | 01/03/2016 |