Provider Demographics
NPI:1508931999
Name:NEUBERG, GERALD WALTER (MD)
Entity Type:Individual
Prefix:DR
First Name:GERALD
Middle Name:WALTER
Last Name:NEUBERG
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 1:3050 CORLEAR AVE # 204
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10463-5180
Mailing Address - Country:US
Mailing Address - Phone:718-601-8720
Mailing Address - Fax:718-601-6102
Practice Address - Street 1:3050 CORLEAR AVE # 204
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10463-5180
Practice Address - Country:US
Practice Address - Phone:718-601-8720
Practice Address - Fax:718-601-6102
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-21
Last Update Date:2012-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY160358207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY61160721Medicaid
NY61160721Medicaid