Provider Demographics
NPI:1780766287
Name:BERGER, TERESA JO (DIPLACMS)
Entity type:Individual
Prefix:
First Name:TERESA
Middle Name:JO
Last Name:BERGER
Suffix:
Gender:F
Credentials:DIPLACMS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:80 KNOLLS CRES
Mailing Address - Street 2:APT. 4J
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10463-6303
Mailing Address - Country:US
Mailing Address - Phone:917-312-5383
Mailing Address - Fax:
Practice Address - Street 1:80 KNOLLS CRES
Practice Address - Street 2:APT. 4J
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10463-6303
Practice Address - Country:US
Practice Address - Phone:917-312-5383
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002456-1171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist