Provider Demographics
NPI:1265522056
Name:BERK, JUDY (CNM)
Entity type:Individual
Prefix:MRS
First Name:JUDY
Middle Name:
Last Name:BERK
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:JUDY
Other - Middle Name:
Other - Last Name:BERK-LEVINE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNM
Mailing Address - Street 1:230 WORCESTER ST
Mailing Address - Street 2:
Mailing Address - City:WELLESLEY
Mailing Address - State:MA
Mailing Address - Zip Code:02481-5420
Mailing Address - Country:US
Mailing Address - Phone:781-431-5429
Mailing Address - Fax:781-431-5548
Practice Address - Street 1:230 WORCESTER ST
Practice Address - Street 2:
Practice Address - City:WELLESLEY
Practice Address - State:MA
Practice Address - Zip Code:02481-5420
Practice Address - Country:US
Practice Address - Phone:781-431-5429
Practice Address - Fax:781-431-5548
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2021-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000033176B00000X
MARN2269233367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No176B00000XOther Service ProvidersMidwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01954443Medicaid