Provider Demographics
NPI:1124176524
Name:BERNA, RENEE A (MD)
Entity type:Individual
Prefix:DR
First Name:RENEE
Middle Name:A
Last Name:BERNA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5045 RTE 130 S
Mailing Address - Street 2:STE E
Mailing Address - City:DELRAN
Mailing Address - State:NJ
Mailing Address - Zip Code:08075-9707
Mailing Address - Country:US
Mailing Address - Phone:856-764-2525
Mailing Address - Fax:856-764-6344
Practice Address - Street 1:5045 RTE 130 S
Practice Address - Street 2:STE E
Practice Address - City:DELRAN
Practice Address - State:NJ
Practice Address - Zip Code:08075-9707
Practice Address - Country:US
Practice Address - Phone:856-764-2525
Practice Address - Fax:856-764-6344
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA068350207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
G99973Medicare UPIN
029384NTRMedicare ID - Type Unspecified