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General NPI Number Information
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NPI Number | 1861639296
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Entity Type | Organization
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Legal Business Name | IRINA BERLIN MEDICAL PC
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Dates
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Enumeration Date | 01/07/2009
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Last Update Date | 05/10/2011
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Provider Practice Location Address
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Address Line | 40 W BRIGHTON AVE SUITE 104
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City | BROOKLYN
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State | NY
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Zip | 11224-4901
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Country | US
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Telephone | 718-627-8300
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Fax | 718-627-8302
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Provider Business Mailing Address
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Address Line | 40 W BRIGHTON AVE SUITE 104
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City | BROOKLYN
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State | NY
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Zip | 11224-4901
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Country | US
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Telephone | 718-627-8300
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Fax | 718-627-8302
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Authorized Official
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Title or Position | PRESIDENT
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Name | MISS IRINA BERLIN
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Credential | M.D.
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Telephone | 718-627-8300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | 211765
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License Number State | NY
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