Provider Demographics
NPI:1093357519
Name:BERMAN, ELIZA (OTD, OTR/L)
Entity Type:Individual
Prefix:
First Name:ELIZA
Middle Name:
Last Name:BERMAN
Suffix:
Gender:F
Credentials:OTD, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:507 E 73RD ST APT 14
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-4059
Mailing Address - Country:US
Mailing Address - Phone:862-368-4964
Mailing Address - Fax:
Practice Address - Street 1:507 E 73RD ST APT 14
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-4059
Practice Address - Country:US
Practice Address - Phone:862-368-4964
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-16
Last Update Date:2019-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY023775225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty