=====================================================
General NPI Number Information
=====================================================
NPI Number | 1598948549
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HOWARD BERK MD PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/13/2007
-----------------------------------------------------
Last Update Date | 12/13/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 206 E 30TH ST
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10016-8202
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-684-0110
-----------------------------------------------------
Fax | 212-684-0125
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 206 E 30TH ST
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10016-8202
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-684-0110
-----------------------------------------------------
Fax | 212-684-0125
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | HOWARD BERK
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 212-684-0116
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | 0782151
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------