Provider Demographics
NPI:1710906615
Name:BERMAN, JOSEPH MONTZINGO
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:MONTZINGO
Last Name:BERMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:149 POMEROY LN
Mailing Address - Street 2:
Mailing Address - City:AMHERST
Mailing Address - State:MA
Mailing Address - Zip Code:01002-2908
Mailing Address - Country:US
Mailing Address - Phone:617-566-1988
Mailing Address - Fax:
Practice Address - Street 1:149 POMEROY LN
Practice Address - Street 2:
Practice Address - City:AMHERST
Practice Address - State:MA
Practice Address - Zip Code:01002-2908
Practice Address - Country:US
Practice Address - Phone:617-566-1988
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA6947225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAY68852Medicare ID - Type Unspecified