Provider Demographics
NPI:1992029110
Name:BERLIN, MELISSA GAIL (MD)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:GAIL
Last Name:BERLIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:GAIL
Other - Last Name:RAPOPORT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:14-23 RIVER RD
Mailing Address - Street 2:
Mailing Address - City:FAIR LAWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07410-1240
Mailing Address - Country:US
Mailing Address - Phone:201-703-0600
Mailing Address - Fax:
Practice Address - Street 1:230 SHERMAN AVE
Practice Address - Street 2:
Practice Address - City:GLEN RIDGE
Practice Address - State:NJ
Practice Address - Zip Code:07028-1529
Practice Address - Country:US
Practice Address - Phone:973-743-2321
Practice Address - Fax:973-259-0600
Is Sole Proprietor?:No
Enumeration Date:2010-03-17
Last Update Date:2019-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA09094700207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ258978WC0Medicare PIN