Individual provider · NPI-1

Dr. Jason S. Berk, D.D.S.

Dentist, Orthodontics and Dentofacial Orthopedics · Stony Brook, NY

NPI number1265676746
StatusActive
Last updated in NPPESNov 21, 2016

Details

NPI
1265676746
Entity type
Individual (NPI-1)
Name
Dr. Jason S. Berk
Credential
D.D.S.
Sex
Male
Sole proprietor
No
Enumeration date
Apr 28, 2009
Last updated
Nov 21, 2016

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics055473-1NYYes
390200000X Student in an Organized Health Care Education/Training Program––

Practice location

Stony Brook University Hospital
Medical Staff Office T14
Stony Brook, NY 11794-7148

Phone 631-444-2754 · Fax 631-444-6031

Mailing address

3 Apricot Ct
Melville, NY 11747-8709

Phone 631-838-9710 · Fax 631-838-9710

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