Provider Demographics
NPI:1457516981
Name:BERKOWITZ, BRUCE ELLIOTT (DMD)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:ELLIOTT
Last Name:BERKOWITZ
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 E 46TH ST
Mailing Address - Street 2:400
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10017-2417
Mailing Address - Country:US
Mailing Address - Phone:212-682-3394
Mailing Address - Fax:212-682-3501
Practice Address - Street 1:20 E 46TH ST
Practice Address - Street 2:400
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10017-2417
Practice Address - Country:US
Practice Address - Phone:212-682-3394
Practice Address - Fax:212-682-3501
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-24
Last Update Date:2008-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY031692122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist