=====================================================
General NPI Number Information
=====================================================
NPI Number | 1104992593
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ADVANCED ORTHOPAEDICS PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/28/2006
-----------------------------------------------------
Last Update Date | 09/11/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8002 KEW GARDENS RD 3RD FLOOR
-----------------------------------------------------
City | KEW GARDENS
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11415
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-575-5454
-----------------------------------------------------
Fax | 718-575-0098
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8002 KEW GARDENS RD 3RD FLOOR
-----------------------------------------------------
City | KEW GARDENS
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11415
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-575-5454
-----------------------------------------------------
Fax | 718-575-0098
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DOV JAY BERKOWITZ
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 718-575-5454
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207X00000X
-----------------------------------------------------
Taxonomy Name | Orthopaedic Surgery Physician
-----------------------------------------------------
License Number | 1523851
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207XX0005X
-----------------------------------------------------
Taxonomy Name | Sports Medicine (Orthopaedic Surgery) Physician
-----------------------------------------------------
License Number | 1523851
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 207XS0114X
-----------------------------------------------------
Taxonomy Name | Adult Reconstructive Orthopaedic Surgery Physician
-----------------------------------------------------
License Number | 1523851
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------