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General NPI Number Information
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NPI Number | 1811186505
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Entity Type | Organization
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Legal Business Name | SUSAN E. BEREY, DMD, P.C.
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Dates
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Enumeration Date | 10/18/2007
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Last Update Date | 10/18/2007
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Provider Practice Location Address
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Address Line | 104 E 74TH ST # 1A
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City | NEW YORK
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State | NY
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Zip | 10021-3544
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Country | US
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Telephone | 212-249-3780
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Fax |
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Provider Business Mailing Address
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Address Line | 174 E 74TH ST APT 4E
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City | NEW YORK
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State | NY
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Zip | 10021-3531
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Country | US
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Telephone | 212-380-1295
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Fax |
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Authorized Official
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Title or Position | ORTHODONTIST
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Name | DR. SUSAN E BEREY
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Credential | DMD
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Telephone | 212-249-3780
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 051463
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License Number State | NY
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