Provider Demographics
NPI:1437108248
Name:BEBERMAN, PAUL GARRETT (DC)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:GARRETT
Last Name:BEBERMAN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1841 BROADWAY
Mailing Address - Street 2:SUITE 505
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10023-7603
Mailing Address - Country:US
Mailing Address - Phone:212-245-2613
Mailing Address - Fax:
Practice Address - Street 1:1841 BROADWAY
Practice Address - Street 2:SUITE 505
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10023-7603
Practice Address - Country:US
Practice Address - Phone:212-245-2613
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-09
Last Update Date:2008-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX010971111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor