Provider Demographics
NPI:1598972325
Name:BERGER, MARC (MD)
Entity Type:Individual
Prefix:
First Name:MARC
Middle Name:
Last Name:BERGER
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 1:301 W 118TH ST
Mailing Address - Street 2:APT PH 2-C
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10026-1049
Mailing Address - Country:US
Mailing Address - Phone:215-353-8828
Mailing Address - Fax:
Practice Address - Street 1:301 W 118TH ST
Practice Address - Street 2:APT PH 2-C
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10026-1049
Practice Address - Country:US
Practice Address - Phone:215-353-8828
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-17
Last Update Date:2017-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY141461-1207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine