MEDICARE: RICHARD S. BERRY MDPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	124011	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	124011-A18	OTHER	NY	HEALTHFIRST
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	4C3563	OTHER	NY	HEALTHNET
4	MCA058903	OTHER	NY	AMERICHOICE
5	0033804	OTHER	NY	GHI
6	10202678	OTHER	NY	AMERIGROUP
7	161917	OTHER	NY	ELDERPLAN
8	4095409	OTHER	NY	AETNA
9	90436	OTHER	NY	AETNA
10	1000055146	OTHER	NY	AFFINITY
11	973731	OTHER	NY	BLUE CROSS & BLUE SHIELD
12	DS086	OTHER	NY	OXFORD
13	622145	OTHER	NY	UNITED HEALTHCARE

General Provider Information

NPI Number	:	1841314994
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RICHARD S. BERRY MDPC

Provider Business Mailing Address
First Line	:	8441 149TH AVE
Second Line	:
City	:	HOWARD BEACH
State	:	NY
Zip	:	11414-1218
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	8441 149TH AVE
Second Line	:
City	:	HOWARD BEACH
State	:	NY
Zip	:	11414-1218
Country	:	US
Telephone Number	:	718-845-1919
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. RICAHRD S BERRY
Credential	:
Telephone Number	:	718-845-1919

Provider Enumeration Date	:	03/16/2007
Last Update Date	:	08/22/2020

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