Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207V00000X | Obstetrician & Gynecologist | 224865 | NY |
N | 207VG0400X | Gynecologist | 224865 | NY |
N | 207VX0000X | Obstetrician | 224865 | NY |
NPI | 1093707572 |
---|---|
Provider Name | Scott Berman |
First Address | Stony Brook, NY 11790-2555 |
Second Address | Stony Brook, NY 11790-2555 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/08/2005 |
Last Update Date | 17/05/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
02359644 | (05) | NY |
H79348 | (02) |