=====================================================
General NPI Number Information
=====================================================
NPI Number | 1770968216
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | OPTOMETRIC OFFICE OF CHERYL BERGER ISRAELOFF, O.D., PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/27/2015
-----------------------------------------------------
Last Update Date | 09/30/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 300 GARDEN CITY PLZ SUITE 404
-----------------------------------------------------
City | GARDEN CITY
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11530-3302
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-224-4888
-----------------------------------------------------
Fax | 516-280-7502
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 300 GARDEN CITY PLZ SUITE 404
-----------------------------------------------------
City | GARDEN CITY
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11530-3302
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. CHERYL BERGER ISRAELOFF
-----------------------------------------------------
Credential | O. D.
-----------------------------------------------------
Telephone | 516-224-4888
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | TUV005206
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------