Basic Information
| Provider Information | |||||||||
| NPI: | 1770568719 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BERGER | ||||||||
| FirstName: | JACK | ||||||||
| MiddleName: | JICCHAK | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 3030 WESTCHESTER AVE | ||||||||
| Address2: | |||||||||
| City: | PURCHASE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 105772574 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9146826511 | ||||||||
| FaxNumber: | 9146076280 | ||||||||
| Practice Location | |||||||||
| Address1: | 3030 WESTCHESTER AVE | ||||||||
| Address2: | |||||||||
| City: | PURCHASE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 105772574 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9146826511 | ||||||||
| FaxNumber: | 9146076280 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/13/2005 | ||||||||
| LastUpdateDate: | 01/21/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RR0500X | 132057 | NY | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Rheumatology | 207RR0500X | 038356 | CT | N | Allopathic & Osteopathic Physicians | Internal Medicine | Rheumatology |
ID Information
| ID | Type | State | Issuer | Description | WP461 | 01 | NY | OXFORD | OTHER | 132057 | 01 | NY | CONNECTICARE | OTHER | 133884168 | 01 | NY | EMPIRE STATE PLAN (NYS) | OTHER | 00597755 | 05 | NY | MEDICAID | 0D1950/3C1296 | 01 | NY | HEALTH NET | OTHER | 133884168 | 01 | NY | MULTIPLAN | OTHER | 4540891 | 01 | NE | AETNA NON HMO | OTHER | 461517 | 01 | NY | UNITED HEALTH CARE | OTHER | 51A531 | 01 | NY | BLUE CROSS PPO | OTHER | 133884168 | 01 | NE | BEECH STREET | OTHER | 133884168 | 01 | NY | POMCO | OTHER | 000000045882 | 01 | NY | GHI HMO | OTHER | 0051090 | 01 | NY | GHI PPO | OTHER | 132057-1W | 01 | NY | WORKERS COMPENSATION | OTHER | 132057 | 01 | NY | HIP | OTHER | 1721079-005 | 01 | NY | CIGNA | OTHER | 2178760 | 01 | NE | AETNA HMO | OTHER | 517105 | 01 | NY | PHCS | OTHER |