Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | 048904 | NY |
NPI | 1154685626 |
---|---|
Provider Name | Dr. Robert W Berls |
First Address | Schenectady, NY 12309-2339 |
Second Address | Schenectady, NY 12309-2339 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/06/2012 |
Last Update Date | 29/06/2012 |