Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 4357 | CT |
NPI | 1063400273 |
---|---|
Provider Name | Dr. Avram Simeon Berger |
First Address | Torrington, CT 06790-3060 |
Second Address | Torrington, CT 06790-3060 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/10/2005 |
Last Update Date | 10/05/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
002043578 | (05) | CT |
T22181 | (02) | CT |