Provider Demographics
NPI:1144274150
Name:BERK, CHARLES (MD)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:
Last Name:BERK
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 1:794 UNION ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11215-1307
Mailing Address - Country:US
Mailing Address - Phone:212-624-1077
Mailing Address - Fax:212-867-4353
Practice Address - Street 1:794 UNION ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11215-1307
Practice Address - Country:US
Practice Address - Phone:212-624-1077
Practice Address - Fax:415-252-7176
Is Sole Proprietor?:No
Enumeration Date:2006-05-22
Last Update Date:2025-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY173438207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01191744Medicaid
NYE62712Medicare UPIN
NY01191744Medicaid
NY37F181Medicare Oscar/Certification