Provider Demographics
NPI:1881867760
Name:BERMAN, GLENN (DC)
Entity Type:Individual
Prefix:
First Name:GLENN
Middle Name:
Last Name:BERMAN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 OVERLOOK TER
Mailing Address - Street 2:
Mailing Address - City:ROSLYN HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11577-1438
Mailing Address - Country:US
Mailing Address - Phone:516-330-3130
Mailing Address - Fax:717-435-7066
Practice Address - Street 1:856 46TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11220-1617
Practice Address - Country:US
Practice Address - Phone:718-435-7000
Practice Address - Fax:718-435-7066
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-11
Last Update Date:2008-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX005893111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYXCWWU1Medicare PIN