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General NPI Number Information
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NPI Number | 1407009574
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Entity Type | Organization
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Legal Business Name | RUXANDRA BERKO PT PC
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Dates
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Enumeration Date | 11/02/2008
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Last Update Date | 11/02/2008
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Provider Practice Location Address
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Address Line | 189 AMOS AVE
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City | OCEANSIDE
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State | NY
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Zip | 11572-2302
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Country | US
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Telephone | 516-705-8988
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Fax | 516-705-8988
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Provider Business Mailing Address
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Address Line | 189 AMOS AVE
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City | OCEANSIDE
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State | NY
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Zip | 11572-2302
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Country | US
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Telephone | 516-705-8988
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Fax | 516-705-8988
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Authorized Official
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Title or Position | PRESIDENT
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Name | RUXANDRA BERKO
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Credential | PHYDICAL THERAPIST
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Telephone | 917-650-4194
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 252Y00000X
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Taxonomy Name | Early Intervention Provider Agency
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License Number | 018347-1
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License Number State | NY
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