Basic Information
| Provider Information | |||||||||
| NPI: | 1073598033 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BERMAN | ||||||||
| FirstName: | JEFFREY | ||||||||
| MiddleName: | O. | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | |||||||||
| OtherFirstName: | |||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | |||||||||
| Mailing Information | |||||||||
| Address1: | 210 WESTCHESTER AVE | ||||||||
| Address2: | |||||||||
| City: | WHITE PLAINS | ||||||||
| State: | NY | ||||||||
| PostalCode: | 106042901 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9146813146 | ||||||||
| FaxNumber: | 9146826403 | ||||||||
| Practice Location | |||||||||
| Address1: | 210 WESTCHESTER AVE | ||||||||
| Address2: | |||||||||
| City: | WHITE PLAINS | ||||||||
| State: | NY | ||||||||
| PostalCode: | 106042901 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9146826488 | ||||||||
| FaxNumber: | 9146826403 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/13/2005 | ||||||||
| LastUpdateDate: | 10/16/2013 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | M | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084N0400X | 199287 | NY | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology |
ID Information
| ID | Type | State | Issuer | Description | 130026394 | 01 | NY | RAILROAD MEDICARE | OTHER | 0004401952 | 01 | NY | AETNA NON HMO | OTHER | 133884168 | 01 | NY | EMPIRE STATE PLAN (NYS) | OTHER | 133884168 | 01 | NY | HIP | OTHER | 7504468-007 | 01 | NY | CIGNA SPECIALTY | OTHER | P1884744 | 01 | NY | OXFORD | OTHER | 2303863 | 01 | NY | UNITED HEALTH CARE | OTHER | 4C5579 | 01 | NY | HEALTHE NET | OTHER | 133884168 | 01 | NY | BEECH STREET | OTHER | 133884168 | 01 | NY | HORIZON HEALTHCARE OF NY | OTHER | 000000074910 | 01 | NY | GHI HMO | OTHER | 133884168 | 01 | NY | MULTIPLAN | OTHER | 133884168 | 01 | NY | POMCO | OTHER | 3000841 | 01 | NY | GHI PPO | OTHER | 133884168 | 01 | NY | PHCS | OTHER | 199287 | 01 | NY | CONNECTICARE | OTHER | 2251863 | 01 | NY | AETNA HMO | OTHER | 59821 | 01 | NY | BLUE CROSS | OTHER | 199287-4-W | 01 | NY | WORKERS COMPENSATION | OTHER |