Provider Demographics
NPI:1548203995
Name:BERGER, BARBARA J (MD)
Entity type:Individual
Prefix:
First Name:BARBARA
Middle Name:J
Last Name:BERGER
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 1:16215 HIGHLAND AVE
Mailing Address - Street 2:SUITE 1F
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11432-3452
Mailing Address - Country:US
Mailing Address - Phone:718-661-9722
Mailing Address - Fax:
Practice Address - Street 1:16215 HIGHLAND AVE
Practice Address - Street 2:SUITE 1F
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11432-3452
Practice Address - Country:US
Practice Address - Phone:718-661-9722
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-14
Last Update Date:2010-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY135052207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00834693Medicaid
E35927Medicare UPIN
NY00834693Medicaid