Provider Demographics
NPI:1770725699
Name:BERG, ROBERT WARREN (DMD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:WARREN
Last Name:BERG
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 1:901 LEXINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10065-5924
Mailing Address - Country:US
Mailing Address - Phone:212-794-1100
Mailing Address - Fax:212-288-9453
Practice Address - Street 1:901 LEXINGTON AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10065-5924
Practice Address - Country:US
Practice Address - Phone:212-794-1100
Practice Address - Fax:212-288-9453
Is Sole Proprietor?:No
Enumeration Date:2009-03-25
Last Update Date:2011-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0515291223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics