Healthcare Provider Details

I. General information

NPI: 1720147606
Provider Name (Legal Business Name): BERRY HILL MEDICAL ASSOCIATES, MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/07/2006
Last Update Date: 02/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

898 OYSTER BAY RD A
EAST NORWICH NY
11732-1051
US

IV. Provider business mailing address

898 OYSTER BAY RD A
EAST NORWICH NY
11732-1051
US

V. Phone/Fax

Practice location:
  • Phone: 516-922-6546
  • Fax: 516-922-6811
Mailing address:
  • Phone: 516-922-6546
  • Fax: 516-922-6811

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number125202
License Number StateNY

VIII. Authorized Official

Name: ALAN J. NELSON
Title or Position: PRESIDENT
Credential: M.D.
Phone: 516-922-6546