Healthcare Provider Details

I. General information

NPI: 1811186505
Provider Name (Legal Business Name): SUSAN E. BEREY, DMD, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2007
Last Update Date: 10/18/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 E 74TH ST # 1A
NEW YORK NY
10021-3544
US

IV. Provider business mailing address

174 E 74TH ST APT 4E
NEW YORK NY
10021-3531
US

V. Phone/Fax

Practice location:
  • Phone: 212-249-3780
  • Fax:
Mailing address:
  • Phone: 212-380-1295
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number051463
License Number StateNY

VIII. Authorized Official

Name: DR. SUSAN E BEREY
Title or Position: ORTHODONTIST
Credential: DMD
Phone: 212-249-3780