Healthcare Provider Details

I. General information

NPI: 1427283944
Provider Name (Legal Business Name): MYRIAM BERTHNELL JOSEPH ANP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/28/2009
Last Update Date: 12/09/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

803 STERLING PL
BROOKLYN NY
11216-3903
US

IV. Provider business mailing address

650 FULTON ST
BROOKLYN NY
11217
US

V. Phone/Fax

Practice location:
  • Phone: 718-613-1700
  • Fax: 718-363-1050
Mailing address:
  • Phone: 718-596-9800
  • Fax: 718-596-9812

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberF304982-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number579102-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: