Basic Information
| Provider Information | |||||||||
| NPI: | 1811154362 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BERKMAN | ||||||||
| FirstName: | DOUGLAS | ||||||||
| MiddleName: | SHARLIN | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D., SC.M. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1 DIAMOND HILL RD | ||||||||
| Address2: | |||||||||
| City: | BERKELEY HEIGHTS | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 079222104 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9082734300 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 243 ROUTE 130 STE 100 | ||||||||
| Address2: | |||||||||
| City: | BORDENTOWN | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 085052137 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8773882778 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/21/2008 | ||||||||
| LastUpdateDate: | 03/04/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/04/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208800000X | MD439845 | PA | N | Allopathic & Osteopathic Physicians | Urology | 208800000X | 237376 | NY | N | Allopathic & Osteopathic Physicians | Urology | 208800000X | 25MA08723600 | NJ | Y | Allopathic & Osteopathic Physicians | Urology |
ID Information
| ID | Type | State | Issuer | Description | 0231011 | 05 | NJ | MEDICAID |