Provider Demographics
NPI:1063798189
Name:BERMAN, KRISTINA
Entity type:Individual
Prefix:MISS
First Name:KRISTINA
Middle Name:
Last Name:BERMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2607 EMMONS AVE
Mailing Address - Street 2:APT 3 A
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-2723
Mailing Address - Country:US
Mailing Address - Phone:917-318-4433
Mailing Address - Fax:
Practice Address - Street 1:2607 EMMONS AVE
Practice Address - Street 2:APT 3 A
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-2723
Practice Address - Country:US
Practice Address - Phone:917-318-4433
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-03
Last Update Date:2011-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016579225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist