Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NS0005X | Chiropractic Sports Physician | 38MC00275300 | NJ |
NPI | 1275506032 |
---|---|
Provider Name | Dr. Ronald David Berju |
First Address | Hillsborough, NJ 08844-4526 |
Second Address | Hillsborough, NJ 08844-4526 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/02/2006 |
Last Update Date | 06/05/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1956906 | (05) | NJ |
3212106 | (05) | NJ |