Provider Demographics
NPI:1871855593
Name:BERGER, NICOLE (MS SPECIAL ED)
Entity Type:Individual
Prefix:MS
First Name:NICOLE
Middle Name:
Last Name:BERGER
Suffix:
Gender:F
Credentials:MS SPECIAL ED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 W 83RD ST
Mailing Address - Street 2:8E
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10024-4919
Mailing Address - Country:US
Mailing Address - Phone:212-877-1419
Mailing Address - Fax:
Practice Address - Street 1:215 W 83RD ST
Practice Address - Street 2:8E
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10024-4919
Practice Address - Country:US
Practice Address - Phone:212-877-1419
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-08
Last Update Date:2012-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY451384921174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist