Provider Demographics
NPI:1912122375
Name:BERG, SCOTT (DC)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:
Last Name:BERG
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:195 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:BETHPAGE
Mailing Address - State:NY
Mailing Address - Zip Code:11714-4428
Mailing Address - Country:US
Mailing Address - Phone:516-433-4114
Mailing Address - Fax:516-938-3820
Practice Address - Street 1:195 PARK AVE
Practice Address - Street 2:
Practice Address - City:BETHPAGE
Practice Address - State:NY
Practice Address - Zip Code:11714-4428
Practice Address - Country:US
Practice Address - Phone:516-433-4114
Practice Address - Fax:516-938-3820
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY4721120111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor