Basic Information
| Provider Information | |||||||||
| NPI: | 1871601153 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BERKOWER | ||||||||
| FirstName: | ALAN | ||||||||
| MiddleName: | STEWART | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD PHD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3250 WESTCHESTER AVE | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | BRONX | ||||||||
| State: | NY | ||||||||
| PostalCode: | 104614500 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7185189304 | ||||||||
| FaxNumber: | 7185189401 | ||||||||
| Practice Location | |||||||||
| Address1: | 3250 WESTCHESTER AVE | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | BRONX | ||||||||
| State: | NY | ||||||||
| PostalCode: | 104614500 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7185189304 | ||||||||
| FaxNumber: | 7185189401 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/28/2006 | ||||||||
| LastUpdateDate: | 01/02/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Y00000X | 166774 | NY | Y | Allopathic & Osteopathic Physicians | Otolaryngology |
ID Information
| ID | Type | State | Issuer | Description | 01130345 | 05 | NY | MEDICAID |