Healthcare Provider Details

I. General information

NPI: 1457447559
Provider Name (Legal Business Name): RHODA BERGER NPP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2006
Last Update Date: 10/31/2023
Certification Date: 10/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1268 E 14TH ST
BROOKLYN NY
11230-5241
US

IV. Provider business mailing address

1217 DITMAS AVE
BROOKLYN NY
11218-6031
US

V. Phone/Fax

Practice location:
  • Phone: 718-382-0045
  • Fax: 929-306-7445
Mailing address:
  • Phone: 718-469-6922
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberF400389-1
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberF400389
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: