Provider Demographics
NPI:1699759589
Name:BERKLEY, DALE SUE (DPM)
Entity type:Individual
Prefix:DR
First Name:DALE
Middle Name:SUE
Last Name:BERKLEY
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1330 PARKWAY AVE STE 6
Mailing Address - Street 2:
Mailing Address - City:TRENTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08628-3006
Mailing Address - Country:US
Mailing Address - Phone:609-771-4222
Mailing Address - Fax:609-771-6003
Practice Address - Street 1:1330 PARKWAY AVE
Practice Address - Street 2:
Practice Address - City:TRENTON
Practice Address - State:NJ
Practice Address - Zip Code:08628-3006
Practice Address - Country:US
Practice Address - Phone:609-771-4222
Practice Address - Fax:609-771-6003
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-04
Last Update Date:2011-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMD01573213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
580222Medicare PIN
NJBE109793Medicare PIN
NJT44713Medicare UPIN