MEDICARE: RICHARD S. BERRY MDPC

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	174400000X	Specialist	124011	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	124011	OTHER	NY	HIP
2	4095409	OTHER	NY	AETNA
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	0033804	OTHER	NY	GHI
5	308920101	OTHER	NY	HEALTHPLUW
6	973731	OTHER	NY	BLUE CROSS & BLUE SHIELD
7	90436	OTHER	NY	AETNA
8	161917	OTHER	NY	ELDERPLAN
9	MCA058903	OTHER	NY	AMERICHOICE
10	124011-A18	OTHER	NY	HEALTHFIRST
11	4C3563	OTHER	NY	HEALTHNET
12	DS086	OTHER	NY	OXFORD

General Provider Information

NPI Number	:	1952311946
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RICHARD S. BERRY MDPC

Provider Business Mailing Address
First Line	:	2820 OCEAN PKWY
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11235-7958
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2820 OCEAN PKWY
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11235-7958
Country	:	US
Telephone Number	:	718-996-3000
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	RICHARD BERRY
Credential	:	MD
Telephone Number	:	718-996-3000

Provider Enumeration Date	:	08/09/2006
Last Update Date	:	07/14/2008

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