Provider Demographics
NPI:1205901394
Name:BEROOKHIM, MANSOOR (MD)
Entity type:Individual
Prefix:MR
First Name:MANSOOR
Middle Name:
Last Name:BEROOKHIM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 WEST 96 ST
Mailing Address - Street 2:APT 1H
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10025
Mailing Address - Country:US
Mailing Address - Phone:212-666-6900
Mailing Address - Fax:212-666-6910
Practice Address - Street 1:7 WEST 96 ST
Practice Address - Street 2:APT 1H
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10025
Practice Address - Country:US
Practice Address - Phone:212-666-6900
Practice Address - Fax:212-666-6910
Is Sole Proprietor?:No
Enumeration Date:2006-11-22
Last Update Date:2010-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY117326208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYNP003OtherOXFORD
NJ00217267Medicaid
NJ00217267Medicaid
NYNP003OtherOXFORD