Basic Information
Provider Information
NPI: 1124054218
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: BERGA
FirstName: SARAH
MiddleName: LEE
NamePrefix: DR.
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1001 MAIN STREET
Address2: 4TH FLOOR
City: BUFFALO
State: NY
PostalCode: 14203
CountryCode: US
TelephoneNumber: 3367162255
FaxNumber:  
Practice Location
Address1: 1001 MAIN STREET
Address2: 4TH FLOOR
City: BUFFALO
State: NY
PostalCode: 14203
CountryCode: US
TelephoneNumber: 7166368284
FaxNumber:  
Other Information
ProviderEnumerationDate: 06/23/2006
LastUpdateDate: 05/20/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 05/20/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207VE0102X2011-01864NCN Allopathic & Osteopathic PhysiciansObstetrics & GynecologyReproductive Endocrinology
207VE0102X303821-01NYY Allopathic & Osteopathic PhysiciansObstetrics & GynecologyReproductive Endocrinology

No ID Information.


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