Provider Demographics
NPI:1235370842
Name:BERGER, JUDITH (PA)
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:
Last Name:BERGER
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:429 E 75TH ST
Mailing Address - Street 2:6TH FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-3102
Mailing Address - Country:US
Mailing Address - Phone:212-606-1768
Mailing Address - Fax:212-774-7208
Practice Address - Street 1:429 E 75TH ST
Practice Address - Street 2:6TH FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-3102
Practice Address - Country:US
Practice Address - Phone:212-606-1768
Practice Address - Fax:212-774-7208
Is Sole Proprietor?:No
Enumeration Date:2009-03-11
Last Update Date:2016-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013061-1363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant