Provider Demographics
NPI:1881709962
Name:BERG, HERMAN B (MD)
Entity type:Individual
Prefix:
First Name:HERMAN
Middle Name:B
Last Name:BERG
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 1:55-15 LITTLE NECK PKWY
Mailing Address - Street 2:SAVOY MEDICAL PLAZA SUITE L10
Mailing Address - City:LITTLE NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11362
Mailing Address - Country:US
Mailing Address - Phone:718-352-6200
Mailing Address - Fax:718-352-6777
Practice Address - Street 1:55-15 LITTLE NECK PKWY
Practice Address - Street 2:SAVOY MEDICAL PLAZA SUITE L10
Practice Address - City:LITTLE NECK
Practice Address - State:NY
Practice Address - Zip Code:11362
Practice Address - Country:US
Practice Address - Phone:718-352-6200
Practice Address - Fax:718-352-6777
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2012-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY093875207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00246520Medicaid
NY41273Medicare ID - Type Unspecified
NY00246520Medicaid