Provider Demographics
NPI:1043380132
Name:BERMAN, JOAN KATHY (MD)
Entity Type:Individual
Prefix:DR
First Name:JOAN
Middle Name:KATHY
Last Name:BERMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:61 E 86TH ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10028-1068
Mailing Address - Country:US
Mailing Address - Phone:212-876-2200
Mailing Address - Fax:212-860-7653
Practice Address - Street 1:61 E 86TH ST
Practice Address - Street 2:SUITE 1
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10028-1068
Practice Address - Country:US
Practice Address - Phone:212-876-2200
Practice Address - Fax:212-860-7653
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY146719207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY17D111Medicare ID - Type Unspecified
NYC06222Medicare UPIN