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General NPI Number Information
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NPI Number | 1144434879
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Entity Type | Organization
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Legal Business Name | DR. GORDON J. BERG & DR. KENNETH MOSKOWITZ
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Dates
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Enumeration Date | 05/10/2007
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Last Update Date | 08/01/2008
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Provider Practice Location Address
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Address Line | 21409 73RD AVE
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City | BAYSIDE
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State | NY
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Zip | 11364-2947
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Country | US
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Telephone | 718-224-9000
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Fax | 718-224-1348
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Provider Business Mailing Address
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Address Line | 21409 73RD AVE
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City | BAYSIDE
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State | NY
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Zip | 11364-2947
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Country | US
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Telephone | 718-224-9000
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Fax | 718-224-1348
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Authorized Official
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Title or Position | OWNER
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Name | DR. GORDON JAY BERG
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Credential | DPM
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Telephone | 718-224-9000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0131X
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Taxonomy Name | Foot Surgery Podiatrist
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License Number | N002482
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License Number State | NY
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