Provider Demographics
NPI:1609938851
Name:BEREZNY JR, DAVID RICHARD JR (RPA-C, MMS)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:RICHARD
Last Name:BEREZNY JR
Suffix:JR
Gender:M
Credentials:RPA-C, MMS
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Mailing Address - Street 1:680 WESTVIEW DR
Mailing Address - Street 2:
Mailing Address - City:MATTITUCK
Mailing Address - State:NY
Mailing Address - Zip Code:11952-2946
Mailing Address - Country:US
Mailing Address - Phone:631-830-4065
Mailing Address - Fax:631-830-4256
Practice Address - Street 1:185 OLD COUNTRY RD STE 7
Practice Address - Street 2:
Practice Address - City:RIVERHEAD
Practice Address - State:NY
Practice Address - Zip Code:11901-2121
Practice Address - Country:US
Practice Address - Phone:631-830-4065
Practice Address - Fax:631-830-4256
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-14
Last Update Date:2023-03-27
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Provider Licenses
StateLicense IDTaxonomies
NY010257363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQ57378Medicare UPIN