Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | 173108 | NY |
Y | 111NI0900X | Internist | 173108 | NY |
N | 207RX0202X | Medical Oncology | 173108 | NY |
NPI | 1053362970 |
---|---|
Provider Name | Mitchell Russ Berger |
First Address | New Hyde Park, NY 11042-1023 |
Second Address | New Hyde Park, NY 11042-1023 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/05/2006 |
Last Update Date | 30/12/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E85638 | (02) | NY |