Healthcare Provider Details

I. General information

NPI: 1063489318
Provider Name (Legal Business Name): MARC A BEREZIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/07/2006
Last Update Date: 09/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

99 DUTCH HILL RD
ORANGEBURG NY
10962-2106
US

IV. Provider business mailing address

99 DUTCH HILL RD
ORANGEBURG NY
10962-2185
US

V. Phone/Fax

Practice location:
  • Phone: 845-359-1877
  • Fax: 845-359-2449
Mailing address:
  • Phone: 845-359-1877
  • Fax: 845-359-2449

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number1671681
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: