Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0204X | Pediatric Emergency Doctor | 167034 | NY |
NPI | 1013995224 |
---|---|
Provider Name | Dr. Joel Berezow |
First Address | New York, NY 10032-1559 |
Second Address | New York, NY 10032-1559 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/01/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01074359 | (05) | NY |
F77043 | (02) | NY |