Provider Demographics
NPI:1548498934
Name:SEEMA BERY MDPC
Entity type:Organization
Organization Name:SEEMA BERY MDPC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:SEEMA
Authorized Official - Middle Name:
Authorized Official - Last Name:BERY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-844-3232
Mailing Address - Street 1:2 QUEENBERRY WAY
Mailing Address - Street 2:
Mailing Address - City:BASKING RIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07920-3830
Mailing Address - Country:US
Mailing Address - Phone:973-844-3232
Mailing Address - Fax:908-325-0466
Practice Address - Street 1:2 QUEENBERRY WAY
Practice Address - Street 2:
Practice Address - City:BASKING RIDGE
Practice Address - State:NJ
Practice Address - Zip Code:07920-3830
Practice Address - Country:US
Practice Address - Phone:973-844-3232
Practice Address - Fax:908-325-0466
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-24
Last Update Date:2009-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA075701207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0065030Medicaid
NJ0065030Medicaid