Healthcare Provider Details

I. General information

NPI: 1003999210
Provider Name (Legal Business Name): STANLEY ZISSMAN BERMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/23/2006
Last Update Date: 08/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7416 VISTA DEL ARROYO AVE NE
ALBUQUERQUE NM
87109-2941
US

IV. Provider business mailing address

7416 VISTA DEL ARROYO AVE NE
ALBUQUERQUE NM
87109-2941
US

V. Phone/Fax

Practice location:
  • Phone: 505-884-7270
  • Fax:
Mailing address:
  • Phone: 505-884-7270
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RA0201X
TaxonomyAllergy & Immunology (Internal Medicine) Physician
License Number73-88
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: