Provider Demographics
NPI:1184850489
Name:BERZOFSKY, CRAIG ELLIOT (MD)
Entity Type:Individual
Prefix:
First Name:CRAIG
Middle Name:ELLIOT
Last Name:BERZOFSKY
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 1:1055 SAW MILL RIVER RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:ARDSLEY
Mailing Address - State:NY
Mailing Address - Zip Code:10502-1045
Mailing Address - Country:US
Mailing Address - Phone:914-693-7636
Mailing Address - Fax:914-693-5994
Practice Address - Street 1:1055 SAW MILL RIVER RD
Practice Address - Street 2:SUITE 101
Practice Address - City:ARDSLEY
Practice Address - State:NY
Practice Address - Zip Code:10502-1045
Practice Address - Country:US
Practice Address - Phone:914-693-7636
Practice Address - Fax:914-693-5994
Is Sole Proprietor?:No
Enumeration Date:2009-06-02
Last Update Date:2014-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-132054207Y00000X
NY254050207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036132054Medicaid
IL256510169Medicare PIN