Healthcare Provider Details

I. General information

NPI: 1770526840
Provider Name (Legal Business Name): RICHARD BERG DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/14/2006
Last Update Date: 04/27/2021
Certification Date: 04/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

116 E FRONT ST
HANCOCK NY
13783-1242
US

IV. Provider business mailing address

116 E FRONT ST
HANCOCK NY
13783-1242
US

V. Phone/Fax

Practice location:
  • Phone: 607-637-5700
  • Fax: 607-637-5703
Mailing address:
  • Phone: 607-637-5700
  • Fax: 607-637-5703

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number238543
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: