Provider Demographics
NPI:1447290754
Name:BERKOWITZ, MITCHELL (PT)
Entity type:Individual
Prefix:MR
First Name:MITCHELL
Middle Name:
Last Name:BERKOWITZ
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10505 69TH AVE
Mailing Address - Street 2:
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-3372
Mailing Address - Country:US
Mailing Address - Phone:718-896-0722
Mailing Address - Fax:718-896-0722
Practice Address - Street 1:10505 69TH AVE
Practice Address - Street 2:
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-3372
Practice Address - Country:US
Practice Address - Phone:718-896-0722
Practice Address - Fax:718-896-0722
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015255-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY06217Medicare ID - Type UnspecifiedQUEENS