MEDICARE: NANETTE B. SILVERBERG MD PLLC

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	207NP0225X	Pediatric Dermatology Physician	202174	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	202174	OTHER	NY	STATE LICENSE

General Provider Information

NPI Number	:	1477004430
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NANETTE B. SILVERBERG MD PLLC

Provider Business Mailing Address
First Line	:	26 FIREMENS MEMORIAL DR
Second Line	:	SUITE 115
City	:	POMONA
State	:	NY
Zip	:	10970-3553
Country	:	US
Telephone Number	:	845-362-8400
Fax Number	:	845-362-8474

Provider Business Practice Location Address
First Line	:	2839 BRIGHTON 7TH ST
Second Line	:	1ST FLOOR
City	:	BROOKLYN
State	:	NY
Zip	:	11235-5203
Country	:	US
Telephone Number	:	718-332-0270
Fax Number	:	718-332-1318

Authorized Official
Title or Position	:	DIRECTOR
Name	:	KRYSTAL M MCKENNA
Credential	:
Telephone Number	:	800-750-8616

Provider Enumeration Date	:	10/14/2016
Last Update Date	:	10/14/2016

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