Active NPI
Gary Wayne Berson, DDS
- Dentist
- Monticello, NY
National Provider Identifier
1184703191
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 036696
- Practice address
- 523 Broadway
Suite 2
Monticello, NY 12701 - Phone
- (845) 796-3368
- Fax
- (845) 796-4468
- NPI assigned
- Nov 2, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 036696 | NY | Primary |
Addresses
Primary practice location
523 Broadway
Suite 2
Monticello, NY 12701
Mailing address
523 Broadway
Suite 2
Monticello, NY 12701
Phone (845) 796-3368
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 036696 | NY | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1162425600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1395360000000",
"number": "1184703191",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "523 BROADWAY",
"address_2": "SUITE 2",
"city": "MONTICELLO",
"state": "NY",
"postal_code": "12701",
"telephone_number": "845-796-3368",
"fax_number": "845-796-4468"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "523 BROADWAY",
"address_2": "SUITE 2",
"city": "MONTICELLO",
"state": "NY",
"postal_code": "12701",
"telephone_number": "845-796-3368",
"fax_number": "845-796-4468"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BERSON",
"first_name": "GARY",
"middle_name": "WAYNE",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-11-02",
"last_updated": "2014-03-21",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "NY",
"license": "036696",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Monticello, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 21, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.