Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223P0221X | Pediatric Dentist | 057282 | NY |
Y | 1223P0221X | Pediatric Dentist | 22DI02580200 | NJ |
NPI | 1053672808 |
---|---|
Provider Name | Dr. Akiva Bersson |
First Address | Monsey, NY 10952-2401 |
Second Address | Monsey, NY 10952-2401 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/06/2012 |
Last Update Date | 06/08/2014 |