Healthcare Provider Details

I. General information

NPI: 1730212556
Provider Name (Legal Business Name): MARIA BERDELLA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/13/2007
Last Update Date: 04/16/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9 NATHAN D. PERLMAN PLACE BETH ISRAEL MEDICAL CENTER
NEW YORK NY
10003-3851
US

IV. Provider business mailing address

PO BOX 95000-2433
PHILADELPHIA PA
19195-2433
US

V. Phone/Fax

Practice location:
  • Phone: 212-420-4100
  • Fax: 212-420-4107
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0214X
TaxonomyPediatric Pulmonology Physician
License Number187728
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: