Provider Demographics
NPI:1285771311
Name:BERCKES, ROBERT ANTHONY (DC)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:ANTHONY
Last Name:BERCKES
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:199 STATE RT 153
Mailing Address - Street 2:
Mailing Address - City:SECAUCUS
Mailing Address - State:NJ
Mailing Address - Zip Code:07094-3437
Mailing Address - Country:US
Mailing Address - Phone:201-863-6881
Mailing Address - Fax:201-863-7852
Practice Address - Street 1:199 ST ROUTE 153
Practice Address - Street 2:
Practice Address - City:SECAUCUS
Practice Address - State:NJ
Practice Address - Zip Code:07094
Practice Address - Country:US
Practice Address - Phone:201-863-6881
Practice Address - Fax:201-863-7785
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYMCO2514111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1434705Medicaid
NJT45627Medicare UPIN
BE507864Medicare ID - Type Unspecified