Provider Demographics
NPI:1467806273
Name:BERKOWITZ, ELISSA (APN)
Entity type:Individual
Prefix:
First Name:ELISSA
Middle Name:
Last Name:BERKOWITZ
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:ELISSA
Other - Middle Name:
Other - Last Name:KALIVAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:92 2ND ST
Mailing Address - Street 2:
Mailing Address - City:HACKENSACK
Mailing Address - State:NJ
Mailing Address - Zip Code:07601-2191
Mailing Address - Country:US
Mailing Address - Phone:551-996-8647
Mailing Address - Fax:
Practice Address - Street 1:92 2ND ST
Practice Address - Street 2:
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601-2191
Practice Address - Country:US
Practice Address - Phone:551-996-8647
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-18
Last Update Date:2024-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF430956-1363L00000X
NJ26NJ00691800363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner