MEDICARE: YITZHAK BERGER 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	103TC1900X	Counseling Psychologist	011157	NY

General Provider Information

NPI Number	:	1144270935
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YITZHAK BERGER PH.D.

Provider Business Mailing Address
First Line	:	1 OLD COUNTRY RD
Second Line	:	SUITE 271
City	:	CARLE PLACE
State	:	NY
Zip	:	11514-1801
Country	:	US
Telephone Number	:	800-725-6280
Fax Number	:	800-725-6380

Provider Business Practice Location Address
First Line	:	48 CEDAR ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11221-3253
Country	:	US
Telephone Number	:	718-928-3500
Fax Number	:

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

Provider Enumeration Date	:	05/11/2006
Last Update Date	:	07/08/2007

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