Provider Demographics
NPI:1770235582
Name:BERKOWITZ, ARIELLE LEAH
Entity Type:Individual
Prefix:
First Name:ARIELLE
Middle Name:LEAH
Last Name:BERKOWITZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15910 71ST AVE APT 7B
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11365-3071
Mailing Address - Country:US
Mailing Address - Phone:609-663-9488
Mailing Address - Fax:
Practice Address - Street 1:15910 71ST AVE APT 7B
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11365-3071
Practice Address - Country:US
Practice Address - Phone:609-663-9488
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-23
Last Update Date:2022-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant