Basic Information
| Provider Information | |||||||||
| NPI: | 1124007182 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BERBARI | ||||||||
| FirstName: | NICHOLAS | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 222 STATION PLZ N | ||||||||
| Address2: | SUITE 310 | ||||||||
| City: | MINEOLA | ||||||||
| State: | NY | ||||||||
| PostalCode: | 115013808 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5166633822 | ||||||||
| FaxNumber: | 5166634740 | ||||||||
| Practice Location | |||||||||
| Address1: | 222 STATION PLZ N | ||||||||
| Address2: | SUITE 310 | ||||||||
| City: | MINEOLA | ||||||||
| State: | NY | ||||||||
| PostalCode: | 115013808 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5166632051 | ||||||||
| FaxNumber: | 5166634740 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/10/2006 | ||||||||
| LastUpdateDate: | 02/25/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 02/25/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | NYS197111 | NY | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 410881 | 01 | BCBS | OTHER | 2599643 | 01 | GHI | OTHER | P589152 | 01 | OXFORD | OTHER | 01657309 | 05 | NY | MEDICAID | 1C2737 | 01 | HEALTH NET | OTHER | 71454 | 01 | VYTRA | OTHER | 110185212 | 01 | RAILROAD MEDICARE | OTHER | 5506473 | 01 | AETNA | OTHER | 1307778 | 01 | FIRST HEALTH | OTHER | 1453732 | 01 | UNITED HEALTH CARE | OTHER | 433217N | 01 | CIGNA | OTHER |