Provider Demographics
NPI:1699808758
Name:BURGER, JOHN (DO)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:
Last Name:BURGER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113 BUCHANAN RD
Mailing Address - Street 2:
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08820-3672
Mailing Address - Country:US
Mailing Address - Phone:732-494-9411
Mailing Address - Fax:
Practice Address - Street 1:125 PROSPECT ST
Practice Address - Street 2:BURGESS LEE BERLIN, M.D., P.A.
Practice Address - City:SOUTH ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07079-1801
Practice Address - Country:US
Practice Address - Phone:973-761-7755
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-14
Last Update Date:2021-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMB34763207VX0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3024601Medicaid
NJC52898Medicare UPIN
NJ402794PQBMedicare ID - Type Unspecified