Provider Demographics
NPI:1760564827
Name:BERGER, GITTY
Entity Type:Individual
Prefix:
First Name:GITTY
Middle Name:
Last Name:BERGER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:GITTY
Other - Middle Name:
Other - Last Name:BERGER, MS RD CDN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS, RD, CDN
Mailing Address - Street 1:1119 E 31ST ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11210-4732
Mailing Address - Country:US
Mailing Address - Phone:718-677-7315
Mailing Address - Fax:
Practice Address - Street 1:1119 E 31ST ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11210-4732
Practice Address - Country:US
Practice Address - Phone:718-677-7315
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005419133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered