Healthcare Provider Details

I. General information

NPI: 1255548723
Provider Name (Legal Business Name): BARBARA BERGER MS, PA, PC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/16/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

594 BROADWAY SUITE 1213
NEW YORK NY
10012-3233
US

IV. Provider business mailing address

95 E 10TH ST #6
NEW YORK NY
10003-5411
US

V. Phone/Fax

Practice location:
  • Phone: 212-260-1206
  • Fax:
Mailing address:
  • Phone: 212-260-1206
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code102L00000X
TaxonomyPsychoanalyst
License Number000002-2
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: