Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 237935 | NY |
Y | 207QG0300X | Family Doctor - Geriatric Medicine | 237935 | NY |
NPI | 1063479798 |
---|---|
Provider Name | Shawn Anthony Berkowitz |
First Address | Leominster, MA 01453-3290 |
Second Address | Leominster, MA 01453-3290 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/04/2006 |
Last Update Date | 01/11/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
02700838 | (05) | NY |
06158729 | ECFMG # (01) | |
G19442 | (02) | NY |