Healthcare Provider Details

I. General information

NPI: 1922159490
Provider Name (Legal Business Name): MOUNT KISCO FOOT SPECIALISTS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/13/2007
Last Update Date: 10/23/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

344 E MAIN ST STE 206
MOUNT KISCO NY
10549-3036
US

IV. Provider business mailing address

344 E MAIN ST STE 206
MOUNT KISCO NY
10549-3036
US

V. Phone/Fax

Practice location:
  • Phone: 914-666-7367
  • Fax: 914-666-7416
Mailing address:
  • Phone: 914-666-7367
  • Fax: 914-666-7416

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberN005061
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberN005062
License Number StateNY

VIII. Authorized Official

Name: DR. RICHARD ALAN BERLINER
Title or Position: MANAGING PARTNER
Credential: DPM
Phone: 914-666-7367