Healthcare Provider Details

I. General information

NPI: 1598697765
Provider Name (Legal Business Name): AGNESA BERISHA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2026
Last Update Date: 09/11/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 E ECKERSON RD STE 1-3
NEW CITY NY
10956-7159
US

IV. Provider business mailing address

200 E ECKERSON RD STE 1-3
NEW CITY NY
10956-7159
US

V. Phone/Fax

Practice location:
  • Phone: 845-352-0500
  • Fax:
Mailing address:
  • Phone: 845-352-0500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number035734
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: