Provider Demographics
NPI:1386723724
Name:BERMAN, SOFYA (MD)
Entity type:Individual
Prefix:DR
First Name:SOFYA
Middle Name:
Last Name:BERMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11205 QUEENS BLVD
Mailing Address - Street 2:
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-8311
Mailing Address - Country:US
Mailing Address - Phone:347-675-4464
Mailing Address - Fax:718-261-2637
Practice Address - Street 1:11205 QUEENS BLVD
Practice Address - Street 2:
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-8311
Practice Address - Country:US
Practice Address - Phone:718-732-1550
Practice Address - Fax:718-261-2637
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-06
Last Update Date:2023-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY209354-1207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYH84252Medicare UPIN