Provider Demographics
NPI:1831118777
Name:BERGER, SAM (NP)
Entity Type:Individual
Prefix:
First Name:SAM
Middle Name:
Last Name:BERGER
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8881 STATE ROUTE 97
Mailing Address - Street 2:
Mailing Address - City:CALLICOON
Mailing Address - State:NY
Mailing Address - Zip Code:12723-5052
Mailing Address - Country:US
Mailing Address - Phone:845-887-5693
Mailing Address - Fax:845-887-5694
Practice Address - Street 1:8881 STATE ROUTE 97
Practice Address - Street 2:
Practice Address - City:CALLICOON
Practice Address - State:NY
Practice Address - Zip Code:12723-5052
Practice Address - Country:US
Practice Address - Phone:845-887-5693
Practice Address - Fax:845-887-5694
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NYF334297-1363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02738049Medicaid
NY02738049Medicaid