Healthcare Provider Details

I. General information

NPI: 1962469809
Provider Name (Legal Business Name): RANDALL G BERLINER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/26/2006
Last Update Date: 10/24/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4234-1 BRONX BLVD
BRONX NY
10466-2668
US

IV. Provider business mailing address

4234-1 BRONX BLVD
BRONX NY
10466-2801
US

V. Phone/Fax

Practice location:
  • Phone: 718-515-4347
  • Fax: 718-653-8641
Mailing address:
  • Phone: 718-515-4347
  • Fax: 718-653-8641

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number195905
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number195905
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number195905
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: