Basic Information
| Provider Information | |||||||||
| NPI: | 1114284734 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BEREKASHVILI | ||||||||
| FirstName: | KETEVAN | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 211 61 STREET | ||||||||
| Address2: | APT 1 | ||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 11220 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7186301270 | ||||||||
| FaxNumber: | 2013871036 | ||||||||
| Practice Location | |||||||||
| Address1: | 211 61ST ST APT 1 | ||||||||
| Address2: | |||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112203782 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7186301270 | ||||||||
| FaxNumber: | 2013871036 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/20/2012 | ||||||||
| LastUpdateDate: | 03/14/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0204X | 286750 | NY | N | Allopathic & Osteopathic Physicians | Radiology | Vascular & Interventional Radiology | 2084N0400X | 286750 | NY | N | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology | 2084V0102X | 286750 | NY | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Vascular Neurology |
No ID Information.