Provider Demographics
NPI:1124285176
Name:BERG, KEVIN JAMES (MD)
Entity type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:JAMES
Last Name:BERG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:799 BLOOMFIELD AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:VERONA
Mailing Address - State:NJ
Mailing Address - Zip Code:07044-1367
Mailing Address - Country:US
Mailing Address - Phone:973-746-7050
Mailing Address - Fax:973-259-3569
Practice Address - Street 1:799 BLOOMFIELD AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:VERONA
Practice Address - State:NJ
Practice Address - Zip Code:07044-1367
Practice Address - Country:US
Practice Address - Phone:973-746-7050
Practice Address - Fax:973-259-3569
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-19
Last Update Date:2016-03-01
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA08660100207QH0002X, 207Q00000X, 207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
No207QH0002XAllopathic & Osteopathic PhysiciansFamily MedicineHospice and Palliative Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine