Provider Demographics
NPI:1992707079
Name:BERRAN, PATRICIA ANN (DPM)
Entity type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:ANN
Last Name:BERRAN
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 1:1500 PLEASANT VALLEY WAY
Mailing Address - Street 2:STE 305
Mailing Address - City:WEST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07052-2956
Mailing Address - Country:US
Mailing Address - Phone:973-736-9936
Mailing Address - Fax:973-736-7993
Practice Address - Street 1:1500 PLEASANT VALLEY WAY
Practice Address - Street 2:STE 305
Practice Address - City:WEST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07052-2956
Practice Address - Country:US
Practice Address - Phone:973-736-9936
Practice Address - Fax:973-736-7993
Is Sole Proprietor?:No
Enumeration Date:2005-06-02
Last Update Date:2020-11-04
Deactivation Date:2006-03-21
Deactivation Code:
Reactivation Date:2006-03-28
Provider Licenses
StateLicense IDTaxonomies
NJMD002169213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6765408Medicaid
NJ6765408Medicaid
NJU52588Medicare UPIN