Provider Demographics
NPI:1306168422
Name:AVRILL ROY BERKMAN, M.D., P.A.
Entity type:Organization
Organization Name:AVRILL ROY BERKMAN, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LAUREEN
Authorized Official - Middle Name:
Authorized Official - Last Name:BERKMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-228-3668
Mailing Address - Street 1:1140 BLOOMFIELD AVE
Mailing Address - Street 2:SUITE 106
Mailing Address - City:WEST CALDWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:07006-7130
Mailing Address - Country:US
Mailing Address - Phone:973-228-3668
Mailing Address - Fax:973-227-6061
Practice Address - Street 1:1140 BLOOMFIELD AVE
Practice Address - Street 2:SUITE 106
Practice Address - City:WEST CALDWELL
Practice Address - State:NJ
Practice Address - Zip Code:07006-7130
Practice Address - Country:US
Practice Address - Phone:973-228-3668
Practice Address - Fax:973-227-6061
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-16
Last Update Date:2010-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA04147800207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PS157OtherOXFORD INSURANCE COMPANY
D65785Medicare UPIN
568235Medicare PIN