Kerry Bergman, MD
Individual provider Active NPI Pediatric Surgery Physician · Summit, NJ
NPI 1346211174 · NPPES record last updated Jul 17, 2007
Key facts
- NPI
- 1346211174
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pediatric Surgery Physician 2086S0120X
- License
- 25MA05619600 (NJ)
- Practice address
- 99 Beauvoir Ave
Summit, NJ 07901-3533 - Phone
- (973) 971-7185
- NPI assigned
- Jan 30, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 5
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NJ
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20070403000117 | NJ | Practitioner - General Surgery |
2062516958 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Hackensack Meridian Health Medical Group - Specialty Care PC | Current |
Accepting new patients | |
| Hackensack Meridian Health Medical Group - Complex Care PC | Current |
Accepting new patients | |
| Hackensack Meridian Health Medical Group - Specialty Care PC | Current |
Accepting new patients | |
| Practice Associates,Inc | Past | Accepting new patients | |
| Specialty Care of Practice Associates,PA | Past | Accepting new patients |
Locations
4 Industrial Way W
Ste 100
Eatontown, NJ 07724
Phone (732) 935-0407
30 Prospect Ave
Hackensack, NJ 07601
Phone (201) 488-0066
19 Davis Ave
Fl 4
Neptune City, NJ 07753
Phone (732) 212-6598
3600 State Route 66
Fl 3
Neptune City, NJ 07753
Phone (732) 807-0463
1945 State Route 33
Wall Township, NJ 07753
Phone (732) 776-2333
19 Davis Ave
Wall Township, NJ 07753
Phone (732) 776-4551
Interoperability endpoints
- kbergmanmd279289@carlehiedirect.net
- kerry.bergman@direct.hackensackmeridian.org
- https://fhir4.healow.com/fhir/r4/IHJHBD
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Surgery Physician | 2086S0120X | 25MA05619600 | NJ | Yes |
Addresses
Primary practice location
99 Beauvoir Ave
Summit, NJ 07901-3533
Mailing address
PO Box 23831
Newark, NJ 07189-0001
Phone (973) 971-7185
Other providers in Summit, NJ
- Beltrami Caduceus
- Marek Belz
- Savannah B Benedetto
- Barry Benisch
- Richard Berardi
- Glen Berkowitz
- Helen Berman
- Giana B Bernheim
- Eric Michael Bernstein
- Adam Berry
All providers in Summit, NJ · Pediatric Surgery Physician in New Jersey
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 17, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.