Healthcare Provider Details

I. General information

NPI: 1417673641
Provider Name (Legal Business Name): JESSICA PATRICIA BERGER FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/19/2022
Last Update Date: 02/02/2024
Certification Date: 02/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

213 CLEVELAND DR
CROTON ON HUDSON NY
10520-2414
US

IV. Provider business mailing address

213 CLEVELAND DR
CROTON ON HUDSON NY
10520-2414
US

V. Phone/Fax

Practice location:
  • Phone: 914-582-1625
  • Fax:
Mailing address:
  • Phone: 914-582-1625
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number348368
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number660329
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: