Provider Demographics
NPI:1912919077
Name:BERSON, JOAN (MD)
Entity Type:Individual
Prefix:
First Name:JOAN
Middle Name:
Last Name:BERSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 ROLLINGWOOD DR
Mailing Address - Street 2:
Mailing Address - City:NEW CITY
Mailing Address - State:NY
Mailing Address - Zip Code:10956-2006
Mailing Address - Country:US
Mailing Address - Phone:845-634-3600
Mailing Address - Fax:845-634-3600
Practice Address - Street 1:6 ROLLINGWOOD DR
Practice Address - Street 2:
Practice Address - City:NEW CITY
Practice Address - State:NY
Practice Address - Zip Code:10956-2006
Practice Address - Country:US
Practice Address - Phone:845-634-3600
Practice Address - Fax:845-634-3600
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-13
Last Update Date:2020-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1067472084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY106747OtherMEDICAL LICENSE
NY106747OtherMEDICAL LICENSE