Provider Demographics
NPI:1003870429
Name:BERG, PAUL S (MD)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:S
Last Name:BERG
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:130 SHORE RD
Mailing Address - Street 2:#139
Mailing Address - City:PORT WASHINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11050-2205
Mailing Address - Country:US
Mailing Address - Phone:516-684-9229
Mailing Address - Fax:516-977-8589
Practice Address - Street 1:2001 MARCUS AVE
Practice Address - Street 2:SUITE N204
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11042-2061
Practice Address - Country:US
Practice Address - Phone:516-684-9229
Practice Address - Fax:516-977-8589
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-13
Last Update Date:2012-02-07
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Provider Licenses
StateLicense IDTaxonomies
NY198682207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology