Healthcare Provider Details

I. General information

NPI: 1477503266
Provider Name (Legal Business Name): GERALD H BERGER PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/11/2006
Last Update Date: 03/12/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 MARCUS BLVD STE 105
ALBANY NY
12205-5953
US

IV. Provider business mailing address

1 MARCUS BLVD STE 105
ALBANY NY
12205-5953
US

V. Phone/Fax

Practice location:
  • Phone: 518-587-0499
  • Fax: 518-786-6467
Mailing address:
  • Phone: 518-587-0499
  • Fax: 518-786-6467

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number004926
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: