Basic Information
| Provider Information | |||||||||
| NPI: | 1144653437 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BEREZOVSKY | ||||||||
| FirstName: | DAMIAN | ||||||||
| MiddleName: | ESTEBAN | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 240 W THOMAS RD # 400 | ||||||||
| Address2: | |||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850134407 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6024066262 | ||||||||
| FaxNumber: | 6024066261 | ||||||||
| Practice Location | |||||||||
| Address1: | 240 W THOMAS RD # 400 | ||||||||
| Address2: | |||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850134407 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6024066262 | ||||||||
| FaxNumber: | 6024066261 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/09/2013 | ||||||||
| LastUpdateDate: | 10/12/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084N0400X | 53907 | AZ | N | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology | 2084N0400X | 75927 | GA | N | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology | 207WX0109X | 53907 | AZ | Y |
ID Information
| ID | Type | State | Issuer | Description | 75927 | 01 | GA | GA MEDICAL LICENSE | OTHER | RS2013-0696 | 01 | NM | NEW MEXICO TRAINING LICENSE | OTHER | 284746 | 05 | AZ | MEDICAID |