Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 179152 | NY |
N | 111NI0900X | Internist | 179152 | NY |
Y | 207RH0002X | Hospice and Palliative Medicine | 179152 | NY |
NPI | 1295799294 |
---|---|
Provider Name | Dr. Jeffrey T Berger |
First Address | Mineola, NY 11501-3808 |
Second Address | Mineola, NY 11501-3808 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/04/2006 |
Last Update Date | 25/02/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01352354 | (05) | NY |
F23989 | (02) | NY |