Provider Demographics
NPI:1629375563
Name:BERRAK, SU GULSUN G (MD)
Entity Type:Individual
Prefix:
First Name:SU GULSUN
Middle Name:G
Last Name:BERRAK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:3415 BAINBRIDGE AVE FL 5
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10467-2403
Mailing Address - Country:US
Mailing Address - Phone:718-741-2450
Mailing Address - Fax:718-944-5908
Practice Address - Street 1:3415 BAINBRIDGE AVE FL 5
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10467-2403
Practice Address - Country:US
Practice Address - Phone:718-741-2450
Practice Address - Fax:718-944-5908
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-11
Last Update Date:2013-03-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY268377208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics