=====================================================
General NPI Number Information
=====================================================
NPI Number | 1316933740
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | NANETTE B SILVERBERG MD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/21/2005
-----------------------------------------------------
Last Update Date | 04/24/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10 UNION SQ E SUITE 3C
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10003-3314
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-844-8800
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 770 OCEAN PKWY APT 6F
-----------------------------------------------------
City | BROOKLYN
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11230-2158
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-332-0270
-----------------------------------------------------
Fax | 718-332-1318
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207NP0225X
-----------------------------------------------------
Taxonomy Name | Pediatric Dermatology Physician
-----------------------------------------------------
License Number | 202174
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207N00000X
-----------------------------------------------------
Taxonomy Name | Dermatology Physician
-----------------------------------------------------
License Number | 2021741
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------