Provider Demographics
NPI:1235818139
Name:BERMAN, ZORA (RE)
Entity Type:Individual
Prefix:
First Name:ZORA
Middle Name:
Last Name:BERMAN
Suffix:
Gender:F
Credentials:RE
Other - Prefix:
Other - First Name:ZORA
Other - Middle Name:
Other - Last Name:BERMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RE
Mailing Address - Street 1:376 PLEASANT ST
Mailing Address - Street 2:
Mailing Address - City:NORTHAMPTON
Mailing Address - State:MA
Mailing Address - Zip Code:01060-9301
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:376 PLEASANT ST
Practice Address - Street 2:
Practice Address - City:NORTHAMPTON
Practice Address - State:MA
Practice Address - Zip Code:01060-9301
Practice Address - Country:US
Practice Address - Phone:413-575-9227
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-17
Last Update Date:2023-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1989246Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Other
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1989OtherELECTROLOGIST LICENSE NUMBER