Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | MA62121 | NJ |
NPI | 1013088095 |
---|---|
Provider Name | Dr. Ross Berlin |
First Address | Galloway, NJ 08205-4678 |
Second Address | Pomona, NJ 08240-0723 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/11/2006 |
Last Update Date | 20/12/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
6614507 | (05) | NJ |
G12812 | (02) | NJ |