Provider Demographics
NPI:1790282275
Name:BERSANI, ADAM T (DPM)
Entity Type:Individual
Prefix:
First Name:ADAM
Middle Name:T
Last Name:BERSANI
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8132B OSWEGO RD
Mailing Address - Street 2:
Mailing Address - City:LIVERPOOL
Mailing Address - State:NY
Mailing Address - Zip Code:13090-1500
Mailing Address - Country:US
Mailing Address - Phone:315-546-0285
Mailing Address - Fax:315-546-0289
Practice Address - Street 1:8132B OSWEGO RD
Practice Address - Street 2:
Practice Address - City:LIVERPOOL
Practice Address - State:NY
Practice Address - Zip Code:13090-1500
Practice Address - Country:US
Practice Address - Phone:315-546-0285
Practice Address - Fax:315-546-0289
Is Sole Proprietor?:No
Enumeration Date:2018-04-10
Last Update Date:2021-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYNY007177213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist