Healthcare Provider Details

I. General information

NPI: 1992954838
Provider Name (Legal Business Name): NAFTALI G. BERRILL PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/16/2008
Last Update Date: 02/10/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26 COURT ST SUITE 1711
BROOKLYN NY
11242-0103
US

IV. Provider business mailing address

26 COURT ST SUITE 1711
BROOKLYN NY
11242-0103
US

V. Phone/Fax

Practice location:
  • Phone: 718-237-2127
  • Fax: 718-237-0831
Mailing address:
  • Phone: 718-237-2127
  • Fax: 718-237-0831

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number009649
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: