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NPI Code Detail

MEDICARE: JACOB E. BERGER L.M.S.W.

MEDICARE: JACOB E. BERGER L.M.S.W.
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
1101Y00000XCounselor079744NY

General Provider Information

NPI Number : 1720317779
Entity Type Code : Individual
Provider Name (Legal Business Name) : JACOB E. BERGER L.M.S.W.
Provider Business Mailing Address
First Line : 4525 HENRY HUDSON PKWY APT 810
Second Line :
City : BRONX
State : NY
Zip : 10471-3811
Country : US
Telephone Number : 917-885-3424
Fax Number :
Provider Business Practice Location Address
First Line : 4525 HENRY HUDSON PKWY APT 810
Second Line :
City : BRONX
State : NY
Zip : 10471-3811
Country : US
Telephone Number : 917-885-3424
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/21/2009
Last Update Date : 01/15/2010

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