Provider Demographics
NPI:1730615899
Name:BERKOWITZ, SURA (LCCE)
Entity type:Individual
Prefix:
First Name:SURA
Middle Name:
Last Name:BERKOWITZ
Suffix:
Gender:F
Credentials:LCCE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 ROVNA CT
Mailing Address - Street 2:Z#112
Mailing Address - City:MONROE
Mailing Address - State:NY
Mailing Address - Zip Code:10950-7471
Mailing Address - Country:US
Mailing Address - Phone:845-248-0786
Mailing Address - Fax:
Practice Address - Street 1:23 ROVNA CT
Practice Address - Street 2:Z#112
Practice Address - City:MONROE
Practice Address - State:NY
Practice Address - Zip Code:10950-7471
Practice Address - Country:US
Practice Address - Phone:845-248-0786
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-11
Last Update Date:2017-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator