Healthcare Provider Details

I. General information

NPI: 1144274150
Provider Name (Legal Business Name): CHARLES BERK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2006
Last Update Date: 03/17/2025
Certification Date: 03/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

794 UNION ST
BROOKLYN NY
11215-1307
US

IV. Provider business mailing address

794 UNION ST
BROOKLYN NY
11215-1307
US

V. Phone/Fax

Practice location:
  • Phone: 212-624-1077
  • Fax: 415-252-7176
Mailing address:
  • Phone: 212-624-1077
  • Fax: 212-867-4353

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number173438
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: