Provider Demographics
NPI:1487061560
Name:BERKOWITZ, ETANA (CNM)
Entity type:Individual
Prefix:
First Name:ETANA
Middle Name:
Last Name:BERKOWITZ
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:974 ROUTE 45
Mailing Address - Street 2:SUITE 1000
Mailing Address - City:POMONA
Mailing Address - State:NY
Mailing Address - Zip Code:10970-3520
Mailing Address - Country:US
Mailing Address - Phone:845-354-1113
Mailing Address - Fax:845-354-1813
Practice Address - Street 1:974 ROUTE 45
Practice Address - Street 2:SUITE 1000
Practice Address - City:POMONA
Practice Address - State:NY
Practice Address - Zip Code:10970-3520
Practice Address - Country:US
Practice Address - Phone:845-354-1113
Practice Address - Fax:845-354-1813
Is Sole Proprietor?:No
Enumeration Date:2014-07-21
Last Update Date:2014-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF001622367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife