Provider Demographics
NPI:1740241504
Name:OKSANA BERKOVICH MEDICAL PC
Entity type:Organization
Organization Name:OKSANA BERKOVICH MEDICAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:OKSANA
Authorized Official - Middle Name:
Authorized Official - Last Name:BERKOVICH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-863-8663
Mailing Address - Street 1:31 AMANDA AVE
Mailing Address - Street 2:OKSANA BERKOVICH MEDICAL PC
Mailing Address - City:NEW ROCHELLE
Mailing Address - State:NY
Mailing Address - Zip Code:10804
Mailing Address - Country:US
Mailing Address - Phone:718-863-8663
Mailing Address - Fax:718-863-8261
Practice Address - Street 1:2190 BOSTON RD APT 1N
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10462-1217
Practice Address - Country:US
Practice Address - Phone:718-863-8663
Practice Address - Fax:718-863-8261
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-31
Last Update Date:2007-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYWEZ761Medicare ID - Type Unspecified