Provider Demographics
NPI:1457460289
Name:BERCOW, NEIL (MD)
Entity Type:Individual
Prefix:
First Name:NEIL
Middle Name:
Last Name:BERCOW
Suffix:
Gender:M
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:PO BOX 95000-6590
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19195-6590
Mailing Address - Country:US
Mailing Address - Phone:631-465-6297
Mailing Address - Fax:631-465-6524
Practice Address - Street 1:100 PORT WASHINGTON BLVD
Practice Address - Street 2:SUITE G01
Practice Address - City:ROSLYN
Practice Address - State:NY
Practice Address - Zip Code:11576-1353
Practice Address - Country:US
Practice Address - Phone:516-627-2173
Practice Address - Fax:516-365-5813
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2014-08-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY181817208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01511022Medicaid
NYF62461Medicare UPIN
NY01511022Medicaid