Healthcare Provider Details

I. General information

NPI: 1861639296
Provider Name (Legal Business Name): IRINA BERLIN MEDICAL PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/07/2009
Last Update Date: 05/10/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 W BRIGHTON AVE SUITE 104
BROOKLYN NY
11224-4901
US

IV. Provider business mailing address

40 W BRIGHTON AVE SUITE 104
BROOKLYN NY
11224-4901
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 Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number211765
License Number StateNY

VIII. Authorized Official

Name: MISS IRINA BERLIN
Title or Position: PRESIDENT
Credential: M.D.
Phone: 718-627-8300