Berg, Gordon J

Berg, Gordon J is an individual health care provider with primary practice located at 26073 Union Tpke , Glen Oaks NY 11004. He recently has only one registered license in Podiatric Medicine & Surgery Service Providers / Podiatrist, which is considered as his primary health care specialty. Berg, Gordon J can be contacted via phone (718) 347-3447.

Contact Information

Primary practice address
26073 Union Tpke Glen Oaks NY 11004
Phone: (718) 347-3447
Fax: (718) 347-3663
Website:
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Health care specialties

SpecialtyCodeLicense #State
Podiatric Medicine & Surgery Service Providers / Podiatrist 213E00000X N0024821 New York

Profile Details

NPI number 1538135462
LBN Legal business name Berg, Gordon J
Credentials Doctor of Podiatric Medicine (DPM)
Entity Individual
Sole proprietor 1 No
Enumeration date Feb 28th, 2006
Last updated Jul 8th, 2007 - about 17 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1538135462 NPPES
New York MEDICAID 00406042

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