NPIMap

Organization Active NPI

Burgess L. Berlin, M.D., P.a.

  • Specialist
  • South Orange, NJ
National Provider Identifier
1053357574
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
MA30653 Issued in NJ
Legal business name
BURGESS L. BERLIN, M.D., P.A.
Practice address
125 Prospect St
South Orange, NJ 07079-1801
Phone
(973) 761-7755
Fax
(973) 761-6290
NPI assigned
Jun 22, 2006
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Burgess L. Berlin
Title
President
Phone
(973) 761-7755

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Specialist 174400000X MA30653 NJ Primary

Addresses

Primary practice location

125 Prospect St
South Orange, NJ 07079-1801

Mailing address

125 Prospect St
South Orange, NJ 07079-1801
Phone (973) 761-7755

National Provider Directory

National Provider Directory

Locations

125 Prospect St
South Orange, NJ 07079
Phone (973) 761-7755

Practitioners & affiliated clinicians

Practitioners 10

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1150934400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1053357574",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "125 PROSPECT ST",
            "city": "SOUTH ORANGE",
            "state": "NJ",
            "postal_code": "070791801",
            "telephone_number": "973-761-7755",
            "fax_number": "973-761-6290"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "125 PROSPECT ST",
            "city": "SOUTH ORANGE",
            "state": "NJ",
            "postal_code": "070791801",
            "telephone_number": "973-761-7755",
            "fax_number": "973-761-6290"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BURGESS L. BERLIN, M.D., P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-22",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "BERLIN",
        "authorized_official_first_name": "BURGESS",
        "authorized_official_middle_name": "L.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "973-761-7755"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "NJ",
            "license": "MA30653",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in South Orange, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.