Provider Demographics
NPI:1356450258
Name:BERGER, ANTONI (MD)
Entity type:Individual
Prefix:MR
First Name:ANTONI
Middle Name:
Last Name:BERGER
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 1:211 NEW BRITAIN RD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:KENSINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06037-1360
Mailing Address - Country:US
Mailing Address - Phone:860-223-6989
Mailing Address - Fax:860-223-2947
Practice Address - Street 1:211 NEW BRITAIN RD
Practice Address - Street 2:SUITE 104
Practice Address - City:KENSINGTON
Practice Address - State:CT
Practice Address - Zip Code:06037-1360
Practice Address - Country:US
Practice Address - Phone:860-223-6989
Practice Address - Fax:860-223-2947
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2023-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT022818207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT01022818OtherCIGNA
CT010022818CT01OtherANTHEM BS
CT050021OtherCT CARE
CT2V2543OtherHEALTHNET
CT001228188Medicaid
CT566088OtherAETNA
CT110001042Medicare ID - Type Unspecified
B83693Medicare UPIN