Healthcare Provider Details

I. General information

NPI: 1548049208
Provider Name (Legal Business Name): AILENE NICOLE BERRY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/22/2023
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 CHURCH ST
SARATOGA SPRINGS NY
12866-1090
US

IV. Provider business mailing address

211 CHURCH ST
SARATOGA SPRINGS NY
12866-1090
US

V. Phone/Fax

Practice location:
  • Phone: 518-587-3222
  • Fax:
Mailing address:
  • Phone: 518-587-3222
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number032063
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: