Provider Demographics
NPI:1225071145
Name:BERSON, BARRY (MD)
Entity Type:Individual
Prefix:DR
First Name:BARRY
Middle Name:
Last Name:BERSON
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 1:165 E 84TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10028-2049
Mailing Address - Country:US
Mailing Address - Phone:212-535-9770
Mailing Address - Fax:212-988-1520
Practice Address - Street 1:165 E 84TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10028-2049
Practice Address - Country:US
Practice Address - Phone:212-535-9770
Practice Address - Fax:212-988-1520
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2011-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY163679174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYE87990Medicare UPIN
NY81F011Medicare ID - Type Unspecified