Healthcare Provider Details

I. General information

NPI: 1235104191
Provider Name (Legal Business Name): ALEKSANDAR BERIC MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/22/2006
Last Update Date: 08/09/2022
Certification Date: 08/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

530 1ST AVE
NEW YORK NY
10016-6402
US

IV. Provider business mailing address

PO BOX 489
YORKTOWN HEIGHTS NY
10598-0489
US

V. Phone/Fax

Practice location:
  • Phone: 212-263-5074
  • Fax:
Mailing address:
  • Phone: 212-598-6185
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0600X
TaxonomyClinical Neurophysiology Physician
License Number186330
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: