Provider Demographics
NPI:1497842066
Name:BERKOWITZ, BENNETT
Entity Type:Individual
Prefix:
First Name:BENNETT
Middle Name:
Last Name:BERKOWITZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 EXECUTIVE BLVD
Mailing Address - Street 2:SUITE 306
Mailing Address - City:SUFFERN
Mailing Address - State:NY
Mailing Address - Zip Code:10901-4164
Mailing Address - Country:US
Mailing Address - Phone:845-368-3429
Mailing Address - Fax:845-368-8679
Practice Address - Street 1:2 EXECUTIVE BLVD
Practice Address - Street 2:SUITE 306
Practice Address - City:SUFFERN
Practice Address - State:NY
Practice Address - Zip Code:10901-4164
Practice Address - Country:US
Practice Address - Phone:845-368-3429
Practice Address - Fax:845-368-8679
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2015-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY161930207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01087181Medicaid
NYW39551Medicare PIN
NYA61674Medicare UPIN