Healthcare Provider Details

I. General information

NPI: 1568528453
Provider Name (Legal Business Name): ANGELA MARIA BERARDINO GERIATRIC NURSE PRAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/28/2006
Last Update Date: 10/31/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

921 EAST NEW YORK AVE
BKLYN NY
11203-1309
US

IV. Provider business mailing address

170 BURNS ST
FOREST HILLS NY
11375
US

V. Phone/Fax

Practice location:
  • Phone: 718-778-8587
  • Fax: 718-735-8938
Mailing address:
  • Phone: 718-263-2219
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number273442
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberF3404341
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: