Healthcare Provider Details

I. General information

NPI: 1508048356
Provider Name (Legal Business Name): DR. ANDREW M. BERLINER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/04/2007
Last Update Date: 10/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

246 EAST MAIN STREET SUITE 2
CLINTON CT
06413
US

IV. Provider business mailing address

246 EAST MAIN STREET SUITE 2
CLINTON CT
06413
US

V. Phone/Fax

Practice location:
  • Phone: 860-669-1320
  • Fax: 860-669-5186
Mailing address:
  • Phone: 860-669-1320
  • Fax: 860-669-5186

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberP00012CT
License Number StateCT

VIII. Authorized Official

Name: DR. ANDREW MARK BERLINER
Title or Position: PODIATRIST
Credential: DPM
Phone: 860-669-1320