Provider Demographics
NPI:1407675754
Name:BERG, KRIS
Entity type:Individual
Prefix:
First Name:KRIS
Middle Name:
Last Name:BERG
Suffix:
Gender:X
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 MONMOUTH ST APT 214
Mailing Address - Street 2:
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02446-5611
Mailing Address - Country:US
Mailing Address - Phone:908-442-1850
Mailing Address - Fax:
Practice Address - Street 1:101 MONMOUTH ST APT 214
Practice Address - Street 2:
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02446-5611
Practice Address - Country:US
Practice Address - Phone:908-442-1850
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-04
Last Update Date:2024-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program