Basic Information
| Provider Information | |||||||||
| NPI: | 1619094018 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BERRAN | ||||||||
| FirstName: | MARY | ||||||||
| MiddleName: | TRACY | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | NNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 12 GAIL DR | ||||||||
| Address2: | |||||||||
| City: | NEW CITY | ||||||||
| State: | NY | ||||||||
| PostalCode: | 109563606 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8456391981 | ||||||||
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| Practice Location | |||||||||
| Address1: | 525 E 68TH ST | ||||||||
| Address2: | 6 WEST NICU | ||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100214870 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2127460318 | ||||||||
| FaxNumber: | 2127460358 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/23/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LN0005X | F350060 | NY | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Neonatal, Critical Care |
No ID Information.