Provider Demographics
NPI:1831275940
Name:BERK, DAVID
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:BERK
Suffix:
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 1:222 BERGEN BLVD
Mailing Address - Street 2:STE 8
Mailing Address - City:FAIRVIEW
Mailing Address - State:NJ
Mailing Address - Zip Code:07022
Mailing Address - Country:US
Mailing Address - Phone:201-945-1156
Mailing Address - Fax:201-945-0012
Practice Address - Street 1:222 BERGEN BLVD
Practice Address - Street 2:STE 8
Practice Address - City:FAIRVIEW
Practice Address - State:NJ
Practice Address - Zip Code:07022
Practice Address - Country:US
Practice Address - Phone:201-945-1156
Practice Address - Fax:201-945-0012
Is Sole Proprietor?:No
Enumeration Date:2006-10-31
Last Update Date:2007-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00601500111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
078184RB9Medicare PIN
U99515Medicare UPIN