=====================================================
General NPI Number Information
=====================================================
NPI Number | 1699007302
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BERKLEY PHYSICAL MEDICINE, PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/04/2010
-----------------------------------------------------
Last Update Date | 02/04/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6700 W OUTER DR
-----------------------------------------------------
City | DETROIT
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48235-2724
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 248-797-0860
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 26394 HUMBER ST
-----------------------------------------------------
City | HUNTINGTON WOODS
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48070-1222
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | HADASSAH R KREIMAN
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 248-797-0860
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208100000X
-----------------------------------------------------
Taxonomy Name | Physical Medicine & Rehabilitation Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------