MEDICARE: AUDREY BETH BERMAN-DAVIDOWITZ 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	208000000X	Pediatrics Physician	199599	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	199599	OTHER	NY	LICENSE

General Provider Information

NPI Number	:	1205912243
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AUDREY BETH BERMAN-DAVIDOWITZ MD

Provider Business Mailing Address
First Line	:	299 MAPLE ST
Second Line	:
City	:	WEST HEMPSTEAD
State	:	NY
Zip	:	11552-3203
Country	:	US
Telephone Number	:	516-486-0454
Fax Number	:	718-281-8590

Provider Business Practice Location Address
First Line	:	2901 216TH ST
Second Line	:	ST. MARY'S HOSPITAL FOR CHILDREN
City	:	BAYSIDE
State	:	NY
Zip	:	11360-2810
Country	:	US
Telephone Number	:	718-281-8977
Fax Number	:	718-281-8590

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

Provider Enumeration Date	:	10/31/2006
Last Update Date	:	07/10/2024

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