Provider Demographics
NPI:1083721294
Name:BERSON, DANIEL (MD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:
Last Name:BERSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 ROLLINGWOOD DR
Mailing Address - Street 2:
Mailing Address - City:NEW CITY
Mailing Address - State:NY
Mailing Address - Zip Code:10956-2006
Mailing Address - Country:US
Mailing Address - Phone:914-450-2375
Mailing Address - Fax:845-634-3600
Practice Address - Street 1:6 ROLLINGWOOD DR
Practice Address - Street 2:
Practice Address - City:NEW CITY
Practice Address - State:NY
Practice Address - Zip Code:10956-2006
Practice Address - Country:US
Practice Address - Phone:914-450-2375
Practice Address - Fax:845-634-3600
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-24
Last Update Date:2013-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY106055208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
C12298Medicare UPIN