Provider Demographics
NPI:1215194261
Name:BERENHOLTZ, ROY (MD)
Entity Type:Individual
Prefix:DR
First Name:ROY
Middle Name:
Last Name:BERENHOLTZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:ROY
Other - Middle Name:
Other - Last Name:BERENHOLTZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:17918 69TH AVE
Mailing Address - Street 2:
Mailing Address - City:FRESH MEADOWS
Mailing Address - State:NY
Mailing Address - Zip Code:11365-3520
Mailing Address - Country:US
Mailing Address - Phone:718-838-0777
Mailing Address - Fax:
Practice Address - Street 1:17918 69TH AVE
Practice Address - Street 2:
Practice Address - City:FRESH MEADOWS
Practice Address - State:NY
Practice Address - Zip Code:11365-3520
Practice Address - Country:US
Practice Address - Phone:718-838-0777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-19
Last Update Date:2021-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY240666207R00000X, 207L00000X
PAMT191459207LP3000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP3000XAllopathic & Osteopathic PhysiciansAnesthesiologyPediatric Anesthesiology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology