Provider Demographics
NPI:1053315416
Name:BERKE, STANLEY J (MD)
Entity Type:Individual
Prefix:DR
First Name:STANLEY
Middle Name:J
Last Name:BERKE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1600 STEWART AVE
Mailing Address - Street 2:SUITE 306
Mailing Address - City:WESTBURY
Mailing Address - State:NY
Mailing Address - Zip Code:11590-6696
Mailing Address - Country:US
Mailing Address - Phone:516-794-2020
Mailing Address - Fax:516-794-2029
Practice Address - Street 1:1600 STEWART AVENUE
Practice Address - Street 2:SUITE 306
Practice Address - City:WESTBURY
Practice Address - State:NY
Practice Address - Zip Code:11590
Practice Address - Country:US
Practice Address - Phone:516-794-2020
Practice Address - Fax:516-794-2029
Is Sole Proprietor?:No
Enumeration Date:2005-06-13
Last Update Date:2013-12-20
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY151730207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00795455Medicaid
NYA60149Medicare UPIN
NY00795455Medicaid