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NPI Code Detail

MEDICARE: MRS. ASHLEY LEANN BERG PMHNP-BC

MEDICARE: MRS. ASHLEY LEANN BERG PMHNP-BC
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
1363LP0808XPsychiatric/Mental Health Nurse Practitioner407171NY

General Provider Information

NPI Number : 1558971002
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. ASHLEY LEANN BERG PMHNP-BC
Provider Business Mailing Address
First Line : 315 MADISON AVE RM 2000
Second Line :
City : NEW YORK
State : NY
Zip : 10017-5416
Country : US
Telephone Number : 646-661-5225
Fax Number : 929-671-3068
Provider Business Practice Location Address
First Line : 17 E GENESEE ST STE 1
Second Line :
City : AUBURN
State : NY
Zip : 13021-4068
Country : US
Telephone Number : 315-253-9795
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/08/2020
Last Update Date : 03/09/2026

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