=====================================================
General NPI Number Information
=====================================================
NPI Number | 1588187033
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HARRY BERKOWITZ MEDICAL PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/17/2017
-----------------------------------------------------
Last Update Date | 03/17/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 211 BEACH 90TH ST
-----------------------------------------------------
City | ROCKAWAY BEACH
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11693-1501
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 917-612-8277
-----------------------------------------------------
Fax | 646-927-0340
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 795 E 19TH ST
-----------------------------------------------------
City | BROOKLYN
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11230-1807
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 917-612-8277
-----------------------------------------------------
Fax | 646-927-0340
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | HARRY BERKOWITZ
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 718-339-8546
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------