MEDICARE: TERESA BERARDI PA

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	363A00000X	Physician Assistant	5605111	NY

General Provider Information

NPI Number	:	1346333580
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TERESA BERARDI PA

Provider Business Mailing Address
First Line	:	2423 MICKLE AVE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10469-6203
Country	:	US
Telephone Number	:	718-684-5122
Fax Number	:

Provider Business Practice Location Address
First Line	:	1825 EASTCHESTER ROAD
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10461
Country	:	US
Telephone Number	:	718-430-3204
Fax Number	:

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

Provider Enumeration Date	:	10/02/2006
Last Update Date	:	11/18/2011

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Directions to “ TERESA BERARDI PA” Practice Location

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