Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 22DI09751 | NJ |
NPI | 1003991381 |
---|---|
Provider Name | Irwin A Berger |
First Address | Edison, NJ 08817-4679 |
Second Address | Edison, NJ 08817-4679 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/10/2006 |
Last Update Date | 08/07/2007 |