Healthcare Provider Details

I. General information

NPI: 1356508741
Provider Name (Legal Business Name): DANIEL BERLIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/22/2008
Last Update Date: 08/13/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 E RIDGEWOOD AVE EAST WING 2ND FLOOR
RIDGEWOOD NJ
07450-3957
US

IV. Provider business mailing address

1200 E RIDGEWOOD AVE EAST WING 2ND FLOOR
RIDGEWOOD NJ
07450-3957
US

V. Phone/Fax

Practice location:
  • Phone: 201-444-0868
  • Fax: 201-493-0797
Mailing address:
  • Phone: 201-444-0868
  • Fax: 201-493-0797

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number247578
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: