MEDICARE: MITCHELL RUSS BERGER MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	173108	NY
2	207RX0202X	Medical Oncology Physician	173108	NY

General Provider Information

NPI Number	:	1053362970
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MITCHELL RUSS BERGER MD

Provider Business Mailing Address
First Line	:	1999 MARCUS AVE
Second Line	:	SUITE M14
City	:	NEW HYDE PARK
State	:	NY
Zip	:	11042-1023
Country	:	US
Telephone Number	:	516-437-4360
Fax Number	:

Provider Business Practice Location Address
First Line	:	1999 MARCUS AVE
Second Line	:	SUITE M14
City	:	NEW HYDE PARK
State	:	NY
Zip	:	11042-1023
Country	:	US
Telephone Number	:	516-437-4360
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/15/2006
Last Update Date	:	12/30/2011

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