Provider Demographics
NPI:1326045683
Name:BERKMAN, CHARLENE SUE (DMD)
Entity Type:Individual
Prefix:DR
First Name:CHARLENE
Middle Name:SUE
Last Name:BERKMAN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11109 76TH RD
Mailing Address - Street 2:STE A5
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-6476
Mailing Address - Country:US
Mailing Address - Phone:718-268-1945
Mailing Address - Fax:718-544-6550
Practice Address - Street 1:11109 76TH RD
Practice Address - Street 2:STE A5
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-6476
Practice Address - Country:US
Practice Address - Phone:718-268-1945
Practice Address - Fax:718-544-6550
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY33634122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist