Provider Demographics
NPI:1902365927
Name:BERGER, SOPHIE MYRIAM (MD)
Entity Type:Individual
Prefix:
First Name:SOPHIE
Middle Name:MYRIAM
Last Name:BERGER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SOPHIE
Other - Middle Name:MYRIAM
Other - Last Name:JOVIEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:3959 BROADWAY # CHC7-737
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10032-1559
Mailing Address - Country:US
Mailing Address - Phone:212-305-5122
Mailing Address - Fax:212-305-6103
Practice Address - Street 1:3959 BROADWAY # CHC7-737
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10032-1559
Practice Address - Country:US
Practice Address - Phone:212-305-5122
Practice Address - Fax:212-305-6103
Is Sole Proprietor?:No
Enumeration Date:2019-03-19
Last Update Date:2021-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program