Provider Demographics
NPI:1720057599
Name:BERKE, ROBERT (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:
Last Name:BERKE
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 1:103 ALLEN ST
Mailing Address - Street 2:
Mailing Address - City:JAMESTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:14701-6968
Mailing Address - Country:US
Mailing Address - Phone:716-338-0022
Mailing Address - Fax:716-338-1567
Practice Address - Street 1:216 E MAIN ST
Practice Address - Street 2:
Practice Address - City:WESTFIELD
Practice Address - State:NY
Practice Address - Zip Code:14787-1133
Practice Address - Country:US
Practice Address - Phone:716-326-3240
Practice Address - Fax:716-326-3233
Is Sole Proprietor?:No
Enumeration Date:2006-03-15
Last Update Date:2021-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1501092083P0901X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY6402758OtherINDEPENDENT HEALTH
NY000508622007OtherBCBSWNY
NY00010196403OtherUNIVERA
NY00723491Medicaid
NYC59209Medicare UPIN
RB1959Medicare ID - Type Unspecified