Provider Demographics
NPI:1992462758
Name:BERGER, RICHARD (NP-C)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:
Last Name:BERGER
Suffix:
Gender:M
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2950 COLLEGE DR STE 2F
Mailing Address - Street 2:
Mailing Address - City:VINELAND
Mailing Address - State:NJ
Mailing Address - Zip Code:08360-6933
Mailing Address - Country:US
Mailing Address - Phone:856-213-9733
Mailing Address - Fax:856-575-5080
Practice Address - Street 1:2950 COLLEGE DR
Practice Address - Street 2:
Practice Address - City:VINELAND
Practice Address - State:NJ
Practice Address - Zip Code:08360-6933
Practice Address - Country:US
Practice Address - Phone:856-213-9733
Practice Address - Fax:856-575-5080
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-29
Last Update Date:2023-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ01233900363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner