Healthcare Provider Details

I. General information

NPI: 1245291269
Provider Name (Legal Business Name): OKSANA BERKOVICH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/29/2006
Last Update Date: 11/05/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2190 BOSTON RD APT 1N
BRONX NY
10462-1217
US

IV. Provider business mailing address

31 AMANDA LANE
NEW ROCHELLE NY
10804
US

V. Phone/Fax

Practice location:
  • Phone: 718-863-8663
  • Fax: 718-863-8261
Mailing address:
  • Phone: 718-863-8663
  • Fax: 718-863-8261

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number214624
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier02184201
Identifier TypeMEDICAID
Identifier StateNY
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: