Provider Demographics
NPI:1992898563
Name:BERKOVICH, BETSY (DO)
Entity type:Individual
Prefix:DR
First Name:BETSY
Middle Name:
Last Name:BERKOVICH
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7B JOHNSON RD
Mailing Address - Street 2:
Mailing Address - City:LATHAM
Mailing Address - State:NY
Mailing Address - Zip Code:12110-3003
Mailing Address - Country:US
Mailing Address - Phone:518-782-7733
Mailing Address - Fax:
Practice Address - Street 1:7B JOHNSON RD
Practice Address - Street 2:
Practice Address - City:LATHAM
Practice Address - State:NY
Practice Address - Zip Code:12110-3003
Practice Address - Country:US
Practice Address - Phone:518-782-7733
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2015-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2758952080P0006X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0006XAllopathic & Osteopathic PhysiciansPediatricsDevelopmental - Behavioral Pediatrics
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY456ZM1OtherEMPIRE BLUECROOS BLUESHIELD
NY9783416OtherAETNA
NY03932881Medicaid
AZ485103Medicaid
AZ8HBU69OtherMEDICARE PART B - PARKER
AZ485103Medicaid
AZ031307Medicare Oscar/Certification
NY456ZM1OtherEMPIRE BLUECROOS BLUESHIELD
AZHSZ134Medicare PIN