Healthcare Provider Details

I. General information

NPI: 1053923102
Provider Name (Legal Business Name): ERIC D. BERGER LMT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/20/2020
Last Update Date: 08/20/2020
Certification Date: 08/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

939 CENTRAL AVE
PEEKSKILL NY
10566-2008
US

IV. Provider business mailing address

213 CLEVELAND DR
CROTON ON HUDSON NY
10520-2414
US

V. Phone/Fax

Practice location:
  • Phone: 914-488-5763
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number028355
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: