MEDICARE: MRS. SHAINDEL MIRIAM BERKOVITS OTRL

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	225X00000X	Occupational Therapist	011367-1	NY

General Provider Information

NPI Number	:	1083859276
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SHAINDEL MIRIAM BERKOVITS OTRL

Provider Business Mailing Address
First Line	:	361 ARGYLE RD
Second Line	:
City	:	CEDARHURST
State	:	NY
Zip	:	11516-1104
Country	:	US
Telephone Number	:	917-753-5217
Fax Number	:	516-791-6464

Provider Business Practice Location Address
First Line	:	361 ARGYLE RD
Second Line	:
City	:	CEDARHURST
State	:	NY
Zip	:	11516-1104
Country	:	US
Telephone Number	:	917-753-5217
Fax Number	:	516-791-6464

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

Provider Enumeration Date	:	12/02/2008
Last Update Date	:	12/02/2008

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