Provider Demographics
NPI:1083780035
Name:BERMAN, LISA ROBYN (MD)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:ROBYN
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 1:155 W 71ST ST
Mailing Address - Street 2:SUITE 1D
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10023-3836
Mailing Address - Country:US
Mailing Address - Phone:212-724-1027
Mailing Address - Fax:
Practice Address - Street 1:155 W 71ST ST
Practice Address - Street 2:SUITE 1D
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10023-3836
Practice Address - Country:US
Practice Address - Phone:212-724-1027
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-28
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2116182084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYH67744Medicare UPIN
NY091BF1Medicare ID - Type UnspecifiedMEDICARE PROVIDER #