=====================================================
General NPI Number Information
=====================================================
NPI Number | 1518753706
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | PHILIPP BERNING MD, MHBA
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/16/2025
-----------------------------------------------------
Last Update Date | 04/16/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1275 YORK AVE
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10065-6007
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-639-6788
-----------------------------------------------------
Fax | 929-521-5037
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 434 E 72ND ST APT. 6A
-----------------------------------------------------
City | 10021
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10021
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 203-589-5301
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RH0003X
-----------------------------------------------------
Taxonomy Name | Hematology & Oncology Physician
-----------------------------------------------------
License Number | P134540
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------