Healthcare Provider Details

I. General information

NPI: 1942298013
Provider Name (Legal Business Name): RICHARD STEVEN BERCIK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2005
Last Update Date: 05/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 HOWARD AVE YALE PHYSICIANS BUILDING- 3RD FLOOR
NEW HAVEN CT
06519-1369
US

IV. Provider business mailing address

300 GEORGE ST 6TH FLOOR, PO BOX 9805
NEW HAVEN CT
06511-6624
US

V. Phone/Fax

Practice location:
  • Phone: 203-785-4176
  • Fax: 203-785-5886
Mailing address:
  • Phone: 203-785-7998
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number040946
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: