Provider Demographics
NPI:1679893937
Name:KASTER-BERK, ELLEN (PHARMD, CASAC)
Entity Type:Individual
Prefix:MRS
First Name:ELLEN
Middle Name:
Last Name:KASTER-BERK
Suffix:
Gender:F
Credentials:PHARMD, CASAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3584 JEROME AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10467-1006
Mailing Address - Country:US
Mailing Address - Phone:718-653-1537
Mailing Address - Fax:
Practice Address - Street 1:3584 JEROME AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10467-1006
Practice Address - Country:US
Practice Address - Phone:718-653-1537
Practice Address - Fax:718-882-1426
Is Sole Proprietor?:No
Enumeration Date:2010-06-09
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY31857101YA0400X
NY040311183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY101YA0400XMedicaid
NY101YA0400XOtherADDICTION COUNSELOR
NY01420795Medicaid