Provider Demographics
NPI:1881911816
Name:BERKOWITZ DIENSTAG, SARAH (DMD)
Entity type:Individual
Prefix:DR
First Name:SARAH
Middle Name:
Last Name:BERKOWITZ DIENSTAG
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:SARAH
Other - Middle Name:
Other - Last Name:BERKOWITZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:696 HUNGRY HARBOR RD
Mailing Address - Street 2:
Mailing Address - City:VALLEY STREAM
Mailing Address - State:NY
Mailing Address - Zip Code:11581-3039
Mailing Address - Country:US
Mailing Address - Phone:917-576-0315
Mailing Address - Fax:
Practice Address - Street 1:696 HUNGRY HARBOR RD
Practice Address - Street 2:
Practice Address - City:VALLEY STREAM
Practice Address - State:NY
Practice Address - Zip Code:11581-3039
Practice Address - Country:US
Practice Address - Phone:917-576-0315
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-30
Last Update Date:2015-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0555291223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice