Healthcare Provider Details

I. General information

NPI: 1992842066
Provider Name (Legal Business Name): BARBRA BERWALD D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: BARBRA BERWALD D.D.S.

II. Dates (important events)

Enumeration Date: 01/30/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1044 NORTHERN BLVD
ROSLYN NY
11576-1514
US

IV. Provider business mailing address

75 COW NECK RD
PORT WASHINGTON NY
11050-1114
US

V. Phone/Fax

Practice location:
  • Phone: 516-672-1881
  • Fax: 212-425-2120
Mailing address:
  • Phone: 516-883-1498
  • Fax: 212-425-2120

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number047691
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: