MEDICARE: DR. GARY BERKOWITZ PH.D.

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	103TC0700X	Clinical Psychologist	35SI00264700	NJ

General Provider Information

NPI Number	:	1073518718
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GARY BERKOWITZ PH.D.

Provider Business Mailing Address
First Line	:	8217 CADWALADER AVE
Second Line	:
City	:	ELKINS PARK
State	:	PA
Zip	:	19027-2405
Country	:	US
Telephone Number	:	609-440-8897
Fax Number	:

Provider Business Practice Location Address
First Line	:	53 WALTER ST
Second Line	:
City	:	EWING
State	:	NJ
Zip	:	08628-3016
Country	:	US
Telephone Number	:	609-440-8897
Fax Number	:

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

Provider Enumeration Date	:	06/17/2005
Last Update Date	:	12/18/2019

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