Provider Demographics
NPI:1417416413
Name:HAMERLA, BERENICE (MD)
Entity Type:Individual
Prefix:
First Name:BERENICE
Middle Name:
Last Name:HAMERLA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1111 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10128-1234
Mailing Address - Country:US
Mailing Address - Phone:212-534-3000
Mailing Address - Fax:212-996-8420
Practice Address - Street 1:1111 PARK AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10128-1234
Practice Address - Country:US
Practice Address - Phone:212-534-3000
Practice Address - Fax:212-996-8420
Is Sole Proprietor?:No
Enumeration Date:2019-03-19
Last Update Date:2022-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY317609208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics