Healthcare Provider Details

I. General information

NPI: 1932169307
Provider Name (Legal Business Name): IRINA BERLIN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/28/2006
Last Update Date: 03/25/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 W BRIGHTON AVE SUITE # 104
BROOKLYN NY
11224-4902
US

IV. Provider business mailing address

2785 W 5TH ST #23E
BROOKLYN NY
11224-4629
US

V. Phone/Fax

Practice location:
  • Phone: 718-627-8300
  • Fax: 718-627-8302
Mailing address:
  • Phone: 718-627-8300
  • Fax: 718-627-8302

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number211765
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: