Provider Demographics
NPI:1164727400
Name:PETER H BERGLAS, MD, PC
Entity Type:Organization
Organization Name:PETER H BERGLAS, MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:H
Authorized Official - Last Name:BERGLAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-744-6800
Mailing Address - Street 1:136 E 64TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10065-7360
Mailing Address - Country:US
Mailing Address - Phone:212-744-6800
Mailing Address - Fax:212-838-4434
Practice Address - Street 1:136 E 64TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10065-7360
Practice Address - Country:US
Practice Address - Phone:212-744-6800
Practice Address - Fax:212-838-4434
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-18
Last Update Date:2011-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY109163207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
B17689Medicare UPIN