Provider Demographics
NPI:1093807166
Name:TODD J BERMAN DMD, PC
Entity Type:Organization
Organization Name:TODD J BERMAN DMD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TODD
Authorized Official - Middle Name:J
Authorized Official - Last Name:BERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:212-888-7070
Mailing Address - Street 1:307 E 49TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10017-7306
Mailing Address - Country:US
Mailing Address - Phone:212-888-7070
Mailing Address - Fax:212-888-1114
Practice Address - Street 1:307 E 49TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10017-7306
Practice Address - Country:US
Practice Address - Phone:212-888-7070
Practice Address - Fax:212-888-1114
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-28
Last Update Date:2008-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY032561261QS0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS0112XAmbulatory Health Care FacilitiesClinic/CenterOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00382898Medicaid
NYD6C121Medicare ID - Type Unspecified
NY00382898Medicaid