Healthcare Provider Details

I. General information

NPI: 1669643177
Provider Name (Legal Business Name): AARON BERKOVITCH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/13/2008
Last Update Date: 03/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1528 POINT BREEZE PL
FAR ROCKAWAY NY
11691-1628
US

IV. Provider business mailing address

1528 POINT BREEZE PL
FAR ROCKAWAY NY
11691-1628
US

V. Phone/Fax

Practice location:
  • Phone: 347-721-5000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number049575-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: