Provider Demographics
NPI:1699885947
Name:BERGE, SCOTT A (ATC)
Entity type:Individual
Prefix:MR
First Name:SCOTT
Middle Name:A
Last Name:BERGE
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 VAN BLARCOM CT
Mailing Address - Street 2:
Mailing Address - City:SUSSEX
Mailing Address - State:NJ
Mailing Address - Zip Code:07461-4502
Mailing Address - Country:US
Mailing Address - Phone:973-209-9104
Mailing Address - Fax:
Practice Address - Street 1:1832 COUNTY ROUTE 565
Practice Address - Street 2:VERNON TOWNSHIP HIGH SCHOOL
Practice Address - City:VERNON
Practice Address - State:NJ
Practice Address - Zip Code:07461
Practice Address - Country:US
Practice Address - Phone:973-764-2995
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MT000242002255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer