Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | X-005871-1 | NY |
N | 111NS0005X | Chiropractic Sports Physician | X005871-1 | NY |
NPI | 1225034564 |
---|---|
Provider Name | Dr. Michael James Berardis |
First Address | Shrub Oak, NY 10588-1503 |
Second Address | Shrub Oak, NY 10588-1503 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/06/2005 |
Last Update Date | 23/09/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0015178 | GHI ID (01) | NY |
3I025202853 | (05) | NY |
C05871-1 | WORK COMP (01) | NY |
P439476 | OXFORD ID (01) | NY |