Provider Demographics
NPI:1962498311
Name:BERGLAS, PETER H (MD)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:H
Last Name:BERGLAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:136 E 64TH ST
Mailing Address - Street 2:SUITE 2F
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10065-7360
Mailing Address - Country:US
Mailing Address - Phone:212-744-6800
Mailing Address - Fax:212-838-4434
Practice Address - Street 1:136 E 64TH ST
Practice Address - Street 2:SUITE 2F
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10065-7360
Practice Address - Country:US
Practice Address - Phone:212-744-6800
Practice Address - Fax:212-838-4434
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-21
Last Update Date:2015-01-16
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY109163207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
B17689Medicare UPIN
B17689Medicare UPIN