Provider Demographics
NPI:1104967249
Name:BERG, ABBEY LYNN (PHD)
Entity type:Individual
Prefix:DR
First Name:ABBEY
Middle Name:LYNN
Last Name:BERG
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:245 W 107TH ST
Mailing Address - Street 2:APARTMENT 2F
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10025-3049
Mailing Address - Country:US
Mailing Address - Phone:212-866-6533
Mailing Address - Fax:212-866-8638
Practice Address - Street 1:3959 BROADWAY
Practice Address - Street 2:ROOM 503 CENTRAL
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10032-1559
Practice Address - Country:US
Practice Address - Phone:212-305-0656
Practice Address - Fax:212-305-6142
Is Sole Proprietor?:No
Enumeration Date:2007-02-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000494-1231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist