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General NPI Number Information
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NPI Number | 1780140939
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Entity Type | Individual
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Provider Name | REBECCA BERMAN NP
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Gender | Female
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Dates
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Enumeration Date | 02/13/2019
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Last Update Date | 05/09/2019
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Provider Practice Location Address
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Address Line | 38 OLD WHITE LAKE TURNPIKE
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City | SWAN LAKE
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State | NY
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Zip | 12783
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Country | US
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Telephone | 347-528-5521
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Fax |
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Provider Business Mailing Address
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Address Line | MALACHI HANAVI 10/10
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City | BEIT SHEMESH
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State | JERUSALEM
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Zip | 9914123
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Country | IL
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 604938
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 774535
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 344366
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License Number State | NY
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