Healthcare Provider Details

I. General information

NPI: 1740106251
Provider Name (Legal Business Name): MULBERRY PHYSICIAN PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/29/2026
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

139 CENTRE ST PH 118
NEW YORK NY
10013-4559
US

IV. Provider business mailing address

139 CENTRE ST PH 118
NEW YORK NY
10013-4559
US

V. Phone/Fax

Practice location:
  • Phone: 917-715-9823
  • Fax:
Mailing address:
  • Phone: 646-960-1162
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. ANDREW NYEIN
Title or Position: MEMBER
Credential: DO
Phone: 917-715-9823