Healthcare Provider Details

I. General information

NPI: 1609959121
Provider Name (Legal Business Name): NANCY R BERAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/21/2006
Last Update Date: 07/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

645 MARBLE AVE
THORNWOOD NY
10594
US

IV. Provider business mailing address

190 GOLDENS BRIDGE RD WESTCHESTER HEALTH ASSOCIATES
KATONAH NY
10536-2810
US

V. Phone/Fax

Practice location:
  • Phone: 914-769-1600
  • Fax: 914-769-1610
Mailing address:
  • Phone: 914-401-8020
  • Fax: 914-232-3366

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number2157192
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: