Provider Demographics
NPI:1669490777
Name:BERKE, GARY M (MS, CP)
Entity Type:Individual
Prefix:MR
First Name:GARY
Middle Name:M
Last Name:BERKE
Suffix:
Gender:M
Credentials:MS, CP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2001 WINWARD WAY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94404-2499
Mailing Address - Country:US
Mailing Address - Phone:650-365-5861
Mailing Address - Fax:650-365-5896
Practice Address - Street 1:2001 WINWARD WAY
Practice Address - Street 2:SUITE 100
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94404-2499
Practice Address - Country:US
Practice Address - Phone:650-365-5861
Practice Address - Fax:650-365-5896
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CP1628222Z00000X, 224P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist
No222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAXB0016280OtherMEDICAL
CAXB0016280Medicaid
CAXB0016280Medicaid