Provider Demographics
NPI:1124007182
Name:BERBARI, NICHOLAS (MD)
Entity Type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:
Last Name:BERBARI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:222 STATION PLZ N
Mailing Address - Street 2:SUITE 310
Mailing Address - City:MINEOLA
Mailing Address - State:NY
Mailing Address - Zip Code:11501-3808
Mailing Address - Country:US
Mailing Address - Phone:516-663-3822
Mailing Address - Fax:516-663-4740
Practice Address - Street 1:222 STATION PLZ N
Practice Address - Street 2:SUITE 310
Practice Address - City:MINEOLA
Practice Address - State:NY
Practice Address - Zip Code:11501-3808
Practice Address - Country:US
Practice Address - Phone:516-663-2051
Practice Address - Fax:516-663-4740
Is Sole Proprietor?:No
Enumeration Date:2006-01-10
Last Update Date:2021-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYNYS197111207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
410881OtherBCBS
2599643OtherGHI
P589152OtherOXFORD
NY01657309Medicaid
1C2737OtherHEALTH NET
71454OtherVYTRA
110185212OtherRAILROAD MEDICARE
5506473OtherAETNA
1307778OtherFIRST HEALTH
1453732OtherUNITED HEALTH CARE
433217NOtherCIGNA
P589152OtherOXFORD