1225033525 NPI number — MR. OTTO MICHAEL BERK LCSW

Table of content: MR. OTTO MICHAEL BERK LCSW (NPI 1225033525)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225033525 NPI number — MR. OTTO MICHAEL BERK LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BERK
Provider First Name:
OTTO
Provider Middle Name:
MICHAEL
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
LCSW
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:
1225033525
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/15/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6762 BURNS ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FOREST HILLS
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11375-3537
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-544-5522
Provider Business Mailing Address Fax Number:
718-544-2345

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6762 BURNS ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FOREST HILLS
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11375-3537
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-544-5522
Provider Business Practice Location Address Fax Number:
718-544-2345
Provider Enumeration Date:
06/15/2005

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:  R-042031 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 182780P . This is a "HIP NY STATE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 2445244 . This is a "UNITED HEALTH CARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 02480211 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2826599000 . This is a "AMERIHEALTH MULTIPLAN" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 558471000 . This is a "MAGELLAN" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 1050730 . This is a "BEACON HEALTH" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 518370 . This is a "NYSHIP EMPIRE PLAN" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: N797C1 . This is a "BCBS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 10208395 . This is a "AMERIGROUP" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 518370 . This is a "VALUE OPTIONS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 7527622 . This is a "AETNA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 248062964 . This is a "UNITED BEHAVIORAL HEALTH" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 307450 . This is a "HEALTHNET MHN" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: P3462946 . This is a "OXFORD" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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