Provider Demographics
NPI:1811186505
Name:SUSAN E. BEREY, DMD, P.C.
Entity type:Organization
Organization Name:SUSAN E. BEREY, DMD, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORTHODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:E
Authorized Official - Last Name:BEREY
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:212-249-3780
Mailing Address - Street 1:174 E 74TH ST APT 4E
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-3531
Mailing Address - Country:US
Mailing Address - Phone:212-380-1295
Mailing Address - Fax:
Practice Address - Street 1:104 E 74TH ST # 1A
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-3544
Practice Address - Country:US
Practice Address - Phone:212-249-3780
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-18
Last Update Date:2007-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0514631223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty