Provider Demographics
NPI:1013924414
Name:BERMAN, MARK (DMD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:
Last Name:BERMAN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1037 MAIN ST
Mailing Address - Street 2:HUDSON RIVER HEALTHCARE, INC.
Mailing Address - City:PEEKSKILL
Mailing Address - State:NY
Mailing Address - Zip Code:10566-2913
Mailing Address - Country:US
Mailing Address - Phone:914-734-8800
Mailing Address - Fax:914-734-8786
Practice Address - Street 1:1 PARADIES LN
Practice Address - Street 2:HUDSON RIVER HEALTHCARE, INC.
Practice Address - City:NEW PALTZ
Practice Address - State:NY
Practice Address - Zip Code:12561-4031
Practice Address - Country:US
Practice Address - Phone:845-255-4290
Practice Address - Fax:845-255-4295
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2012-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY034244122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00630039Medicaid