1902832355 NPI number — RICHARD D BERKOWITZ MD PA

Table of content: (NPI 1902832355)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902832355 NPI number — RICHARD D BERKOWITZ MD PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RICHARD D BERKOWITZ MD PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
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:
1902832355
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/25/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7171 N UNIVERSITY DR
Provider Second Line Business Mailing Address:
SUITE # 100
Provider Business Mailing Address City Name:
TAMARAC
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33321-2902
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
954-718-7776
Provider Business Mailing Address Fax Number:
954-597-7773

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7171 N UNIVERSITY DR
Provider Second Line Business Practice Location Address:
SUITE # 100
Provider Business Practice Location Address City Name:
TAMARAC
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33321-2902
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
954-718-7776
Provider Business Practice Location Address Fax Number:
954-597-7773
Provider Enumeration Date:
06/25/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BERKOWITZ
Authorized Official First Name:
RICHARD
Authorized Official Middle Name:
DAVID
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
954-718-7776

Provider Taxonomy Codes

  • Taxonomy code: 207X00000X , with the licence number:  ME71454 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 251002 . This is a "AVMED PROVIDER NUMBER" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 9034 . This is a "NEIGHBORHOOD HEALTH" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 32382 . This is a "BCBS OF FLORIDA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 2507820 . This is a "AETNA HMO NUMBER" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 0598628 . This is a "GHI ID #" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 010117100 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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