Provider Demographics
NPI:1558497941
Name:BERGER, EDWARD (OD)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:
Last Name:BERGER
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 MIDDLESEX RD
Mailing Address - Street 2:
Mailing Address - City:EAST GREENBUSH
Mailing Address - State:NY
Mailing Address - Zip Code:12061-2504
Mailing Address - Country:US
Mailing Address - Phone:518-479-4722
Mailing Address - Fax:518-479-4725
Practice Address - Street 1:2 MIDDLESEX RD
Practice Address - Street 2:
Practice Address - City:EAST GREENBUSH
Practice Address - State:NY
Practice Address - Zip Code:12061-2504
Practice Address - Country:US
Practice Address - Phone:518-479-4722
Practice Address - Fax:518-479-4725
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2007-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYVUT0005420152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY10000140OtherCDPHP
NY59129OtherMVP
54365BMedicare UPIN