Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213EP1101X | Primary Podiatric Medicine | N002370 | NY |
NPI | 1588742175 |
---|---|
Provider Name | Dr. Charles Berke |
First Address | Brooklyn, NY 11235-3903 |
Second Address | Brooklyn, NY 11235-3903 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/11/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
P27141 | (02) | NY |