Provider Demographics
NPI:1093881716
Name:BERSON, ROBERT J (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:J
Last Name:BERSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:747 MONTAUK HWY
Mailing Address - Street 2:
Mailing Address - City:WEST ISLIP
Mailing Address - State:NY
Mailing Address - Zip Code:11795-4911
Mailing Address - Country:US
Mailing Address - Phone:631-587-5444
Mailing Address - Fax:631-587-4938
Practice Address - Street 1:747 MONTAUK HWY
Practice Address - Street 2:
Practice Address - City:WEST ISLIP
Practice Address - State:NY
Practice Address - Zip Code:11795-4911
Practice Address - Country:US
Practice Address - Phone:631-587-5444
Practice Address - Fax:631-587-4938
Is Sole Proprietor?:No
Enumeration Date:2006-11-27
Last Update Date:2012-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY118380208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
2194OtherVYTRA
1099813OtherGHI
112677136019OtherCIGNA
118380OtherHIP
522479OtherUNITED HEALTHCARE
NY78L771OtherBCBS
85727OtherUSHC
4093624OtherAETNA
AA00111OtherMDNY
CS167OtherOXFORD
85727OtherUSHC
C05669Medicare UPIN