Provider Demographics
NPI:1558486464
Name:BERMANZOHN, PAUL C
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:C
Last Name:BERMANZOHN
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 1:61 MOUNTAIN RD
Mailing Address - Street 2:
Mailing Address - City:ROSENDALE
Mailing Address - State:NY
Mailing Address - Zip Code:12472-9652
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10 ROSS CIR
Practice Address - Street 2:
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12601-1078
Practice Address - Country:US
Practice Address - Phone:845-452-8000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1528872084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY152887Medicaid
NY152887Medicaid