Provider Demographics
NPI:1558469072
Name:DIANE S BERSON MD PLLC
Entity Type:Organization
Organization Name:DIANE S BERSON MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:S
Authorized Official - Last Name:BERSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-355-3511
Mailing Address - Street 1:211 E 53RD ST
Mailing Address - Street 2:SUITE 3
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10022-4803
Mailing Address - Country:US
Mailing Address - Phone:212-355-3511
Mailing Address - Fax:212-355-3552
Practice Address - Street 1:211 E 53RD ST
Practice Address - Street 2:SUITE 3
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022-4803
Practice Address - Country:US
Practice Address - Phone:212-355-3511
Practice Address - Fax:212-355-3552
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty