MEDICARE: IRINA BERLIN MD

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	207RG0100X	Gastroenterology Physician	211765	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1932169307
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	IRINA BERLIN MD

Provider Business Mailing Address
First Line	:	2785 W 5TH ST
Second Line	:	#23E
City	:	BROOKLYN
State	:	NY
Zip	:	11224-4629
Country	:	US
Telephone Number	:	718-627-8300
Fax Number	:	718-627-8302

Provider Business Practice Location Address
First Line	:	40 W BRIGHTON AVE
Second Line	:	SUITE # 104
City	:	BROOKLYN
State	:	NY
Zip	:	11224-4902
Country	:	US
Telephone Number	:	718-627-8300
Fax Number	:	718-627-8302

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/28/2006
Last Update Date	:	03/25/2013

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