Basic Information
| Provider Information | |||||||||
| NPI: | 1609970805 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BERK | ||||||||
| FirstName: | ROBERT | ||||||||
| MiddleName: | L. | ||||||||
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| Credential: | M.D | ||||||||
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| Mailing Information | |||||||||
| Address1: | 540 WOODBOURNE RD | ||||||||
| Address2: | SUITE 1 | ||||||||
| City: | LANGHORNE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 190471856 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2157506611 | ||||||||
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| Practice Location | |||||||||
| Address1: | 6 EARLIN AVE STE 290 | ||||||||
| Address2: | |||||||||
| City: | BROWNS MILLS | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 080151780 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6095377200 | ||||||||
| FaxNumber: | 6098963986 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/11/2006 | ||||||||
| LastUpdateDate: | 04/26/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/26/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | MD045704L | PA | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 0014846240005 | 05 | PA | MEDICAID |