Individual
NICOLE JOY BERWALD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
475 SEAVIEW AVE, STATEN ISLAND, NY 10305
(718) 226-9158
(718) 226-6964
Mailing address
ONE EDGEWATER STREET, 6TH FLOOR, STATEN ISLAND, NY 10305
(718) 226-4324
(718) 226-1039
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
245711
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02983695
—
NY
Enumeration date
02/12/2008
Last updated
12/16/2010
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