Provider Demographics
NPI:1003892969
Name:BERGER, WILLIAM J (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:J
Last Name:BERGER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:2001 MARCUS AVE
Mailing Address - Street 2:SUITE S250
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11042-1011
Mailing Address - Country:US
Mailing Address - Phone:516-488-4428
Mailing Address - Fax:516-328-2723
Practice Address - Street 1:1201 NORTHERN BLVD STE 201
Practice Address - Street 2:
Practice Address - City:MANHASSET
Practice Address - State:NY
Practice Address - Zip Code:11030-3001
Practice Address - Country:US
Practice Address - Phone:516-488-4428
Practice Address - Fax:516-328-2723
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-21
Last Update Date:2017-12-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY147427207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY08307OtherGHI MEDICARE
NY370071POtherHIP
NY0096071OtherGHI
NY147427-9OtherWORKMANS COMP
NY29434OtherAETNA
NY26336OtherVYTRA
NYAS566OtherOXFORD
NY00963837-9Medicaid
NY147427-9OtherWORKMANS COMP
NY00963837-9Medicaid