Provider Demographics
NPI:1144267006
Name:BERSCHADSKY, MARIO III
Entity type:Individual
Prefix:DR
First Name:MARIO
Middle Name:
Last Name:BERSCHADSKY
Suffix:III
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 CAMBRAY RD
Mailing Address - Street 2:
Mailing Address - City:MONTVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07045-9579
Mailing Address - Country:US
Mailing Address - Phone:973-227-7908
Mailing Address - Fax:973-227-7908
Practice Address - Street 1:19 CAMBRAY RD
Practice Address - Street 2:
Practice Address - City:MONTVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07045-9579
Practice Address - Country:US
Practice Address - Phone:973-227-7908
Practice Address - Fax:973-227-7908
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA02637100208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJBEO55090Medicare ID - Type Unspecified