1053412254 NPI number — MR. BERTON KLEIN FRANK LCSWR

Table of content: MR. BERTON KLEIN FRANK LCSWR (NPI 1053412254)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053412254 NPI number — MR. BERTON KLEIN FRANK LCSWR

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FRANK
Provider First Name:
BERTON
Provider Middle Name:
KLEIN
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
LCSWR
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1053412254
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/28/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
124 HORSESHOE HILL RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
POUND RIDGE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10576
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
914-764-0350
Provider Business Mailing Address Fax Number:
914-764-0350

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
185 ADAMS ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BEDFORD HILLS
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10507
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
914-764-0350
Provider Business Practice Location Address Fax Number:
914-764-0350
Provider Enumeration Date:
09/26/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  R028024 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 1041C0700X , with the licence number: R0280241 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1611193 . This is a "OXFORD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 7445052 . This is a "MANAGED CHOICE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 195595 . This is a "MHN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 14R028024CT02 . This is a "ANTHEM" identifier . This identifiers is of the category "OTHER".
  • Identifier: 400429 . This is a "GHI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2537085 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 828290 . This is a "FIRST HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: N44321 . This is a "EMPIRE" identifier . This identifiers is of the category "OTHER".




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