MEDICARE: DR. PAUL MICHAEL BERGER-GROSS 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	103G00000X	Clinical Neuropsychologist	8525	NY

General Provider Information

NPI Number	:	1891794798
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PAUL MICHAEL BERGER-GROSS PH.D.

Provider Business Mailing Address
First Line	:	5900 ARLINGTON AVE
Second Line	:	APT. 16B
City	:	RIVERDALE
State	:	NY
Zip	:	10471-1302
Country	:	US
Telephone Number	:	718-281-8824
Fax Number	:

Provider Business Practice Location Address
First Line	:	2901 216TH ST
Second Line	:
City	:	BAYSIDE
State	:	NY
Zip	:	11360-2810
Country	:	US
Telephone Number	:	718-281-8824
Fax Number	:

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

Provider Enumeration Date	:	07/21/2005
Last Update Date	:	07/08/2007

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