MEDICARE: DAVID BEREZOW

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	174400000X	Specialist

General Provider Information

NPI Number	:	1699298851
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID BEREZOW

Provider Business Mailing Address
First Line	:	247 E 33RD ST APT 1B
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10016-4807
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	247 E 33RD ST APT 1B
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10016-4807
Country	:	US
Telephone Number	:	151-633-0568
Fax Number	:

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

Provider Enumeration Date	:	07/19/2017
Last Update Date	:	07/19/2017

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Directions to “ DAVID BEREZOW ” Practice Location

Language	Start Address	Practice Location

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