Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | 173585 | NY |
NPI | 1003830886 |
---|---|
Provider Name | Shelley R. Berson |
First Address | West Nyack, NY 10994 |
Second Address | West Nyack, NY 10994-1847 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/07/2006 |
Last Update Date | 21/06/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
02153667 | (05) | NY |
F20755 | (02) | NY |