Provider Demographics
NPI:1790964229
Name:BERAKA MD PLASTIC SURGERY PLLC
Entity Type:Organization
Organization Name:BERAKA MD PLASTIC SURGERY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:BERAKA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-288-1122
Mailing Address - Street 1:875 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10075-0341
Mailing Address - Country:US
Mailing Address - Phone:212-288-1122
Mailing Address - Fax:212-288-1129
Practice Address - Street 1:875 PARK AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10075-0341
Practice Address - Country:US
Practice Address - Phone:212-288-1122
Practice Address - Fax:212-288-1129
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-01
Last Update Date:2007-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty