Provider Demographics
NPI:1174670632
Name:BERMAN, SANDRA M (MD)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:M
Last Name:BERMAN
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:75 LIVINGSTON ST
Mailing Address - Street 2:APT 14A
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11201-5088
Mailing Address - Country:US
Mailing Address - Phone:718-797-5339
Mailing Address - Fax:718-522-2211
Practice Address - Street 1:149 CONGRESS ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-6103
Practice Address - Country:US
Practice Address - Phone:718-797-5339
Practice Address - Fax:718-522-2211
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-05
Last Update Date:2015-09-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY143791-1207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0060814OtherGHI
NYKP010OtherOXFORD
NYC06891Medicare UPIN
NYSB022D2910Medicare ID - Type Unspecified