MEDICARE: DR. EVAN R BERGER MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	109138	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	109138	OTHER	NY	LICENSE

General Provider Information

NPI Number	:	1225032204
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EVAN R BERGER MD

Provider Business Mailing Address
First Line	:	235 N BELLE MEAD RD
Second Line	:
City	:	EAST SETAUKET
State	:	NY
Zip	:	11733-3456
Country	:	US
Telephone Number	:	631-751-3000
Fax Number	:	631-751-3366

Provider Business Practice Location Address
First Line	:	235 N BELLE MEAD RD
Second Line	:
City	:	EAST SETAUKET
State	:	NY
Zip	:	11733-3456
Country	:	US
Telephone Number	:	631-751-3000
Fax Number	:	631-751-3366

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/08/2005
Last Update Date	:	03/07/2023

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