Provider Demographics
NPI:1104185289
Name:STANLEY J BERKE MD PC
Entity Type:Organization
Organization Name:STANLEY J BERKE MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:STANLEY
Authorized Official - Middle Name:J
Authorized Official - Last Name:BERKE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-794-2020
Mailing Address - Street 1:1600 STEWART AVE
Mailing Address - Street 2:SUITE 306
Mailing Address - City:WESTBURY
Mailing Address - State:NY
Mailing Address - Zip Code:11590-6696
Mailing Address - Country:US
Mailing Address - Phone:516-794-2020
Mailing Address - Fax:516-794-2029
Practice Address - Street 1:901 STEWART AVE
Practice Address - Street 2:SUITE 255
Practice Address - City:GARDEN CITY
Practice Address - State:NY
Practice Address - Zip Code:11530-4893
Practice Address - Country:US
Practice Address - Phone:516-794-2020
Practice Address - Fax:516-794-2029
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-10
Last Update Date:2013-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY151730207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00795455Medicaid
NY05D771Medicare PIN
NY00795455Medicaid