1992029110 NPI number — MELISSA GAIL BERLIN MD

Table of content: MELISSA GAIL BERLIN MD (NPI 1992029110)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992029110 NPI number — MELISSA GAIL BERLIN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BERLIN
Provider First Name:
MELISSA
Provider Middle Name:
GAIL
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
RAPOPORT
Provider Other First Name:
MELISSA
Provider Other Middle Name:
GAIL
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1992029110
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
14-23 RIVER RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FAIR LAWN
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07410-1240
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
201-703-0600
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
230 SHERMAN AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GLEN RIDGE
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07028-1529
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
973-743-2321
Provider Business Practice Location Address Fax Number:
973-259-0600
Provider Enumeration Date:
03/17/2010

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  25MA09094700 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)