Basic Information
| Provider Information | |||||||||
| NPI: | 1720057599 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BERKE | ||||||||
| FirstName: | ROBERT | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 103 ALLEN ST | ||||||||
| Address2: | |||||||||
| City: | JAMESTOWN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 147016968 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7163380022 | ||||||||
| FaxNumber: | 7163381567 | ||||||||
| Practice Location | |||||||||
| Address1: | 216 E MAIN ST | ||||||||
| Address2: | |||||||||
| City: | WESTFIELD | ||||||||
| State: | NY | ||||||||
| PostalCode: | 147871133 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7163263240 | ||||||||
| FaxNumber: | 7163263233 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/15/2006 | ||||||||
| LastUpdateDate: | 10/01/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| NPICertificationDate: | 10/01/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2083P0901X | 150109 | NY | N | Allopathic & Osteopathic Physicians | Preventive Medicine | Public Health & General Preventive Medicine | 208D00000X | 150109 | NY | Y | Allopathic & Osteopathic Physicians | General Practice |
ID Information
| ID | Type | State | Issuer | Description | 6402758 | 01 | NY | INDEPENDENT HEALTH | OTHER | 000508622007 | 01 | NY | BCBSWNY | OTHER | 00010196403 | 01 | NY | UNIVERA | OTHER | 00723491 | 05 | NY | MEDICAID |