Healthcare Provider Details

I. General information

NPI: 1295799294
Provider Name (Legal Business Name): JEFFREY T BERGER M.D.,
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/14/2006
Last Update Date: 02/25/2021
Certification Date: 02/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 STATION PLZ N SUITE 518
MINEOLA NY
11501-3808
US

IV. Provider business mailing address

222 STATION PLZ N SUITE 518
MINEOLA NY
11501-3808
US

V. Phone/Fax

Practice location:
  • Phone: 516-663-2588
  • Fax: 516-663-4644
Mailing address:
  • Phone: 516-663-2588
  • Fax: 516-663-4644

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number179152
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number179152
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License Number179152
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: