Provider Demographics
NPI:1396787412
Name:BERMAN, DEAN (DO)
Entity type:Individual
Prefix:DR
First Name:DEAN
Middle Name:
Last Name:BERMAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:680 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:MASSAPEQUA
Mailing Address - State:NY
Mailing Address - Zip Code:11758-2317
Mailing Address - Country:US
Mailing Address - Phone:516-797-0100
Mailing Address - Fax:
Practice Address - Street 1:680 BROADWAY
Practice Address - Street 2:
Practice Address - City:MASSAPEQUA
Practice Address - State:NY
Practice Address - Zip Code:11758-2317
Practice Address - Country:US
Practice Address - Phone:516-797-0100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-12
Last Update Date:2013-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY151210208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
B80339Medicare UPIN
NY98D791Medicare ID - Type Unspecified