MEDICARE: NEOMY MEDICAL, PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QP2000X	Physical Therapy Clinic/Center	187053	NY
2	261QP3300X	Pain Clinic/Center	187053	NY

General Provider Information

NPI Number	:	1205840295
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEOMY MEDICAL, PC

Provider Business Mailing Address
First Line	:	1122 CONEY ISLAND AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11230-2345
Country	:	US
Telephone Number	:	718-859-0090
Fax Number	:	718-859-0048

Provider Business Practice Location Address
First Line	:	1122 CONEY ISLAND AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11230-2345
Country	:	US
Telephone Number	:	718-859-0090
Fax Number	:	718-859-0048

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. RICHARD BERARDI
Credential	:	DO
Telephone Number	:	718-859-0090

Provider Enumeration Date	:	07/28/2006
Last Update Date	:	09/11/2025

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