Provider Demographics
NPI:1073235701
Name:BALDWIN HARBOR PODIATRY
Entity Type:Organization
Organization Name:BALDWIN HARBOR PODIATRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KIM
Authorized Official - Middle Name:
Authorized Official - Last Name:BERLIN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:516-623-4580
Mailing Address - Street 1:830 ATLANTIC AVE STE A
Mailing Address - Street 2:
Mailing Address - City:BALDWIN
Mailing Address - State:NY
Mailing Address - Zip Code:11510-4098
Mailing Address - Country:US
Mailing Address - Phone:516-623-4580
Mailing Address - Fax:516-623-4588
Practice Address - Street 1:830 ATLANTIC AVE STE A
Practice Address - Street 2:
Practice Address - City:BALDWIN
Practice Address - State:NY
Practice Address - Zip Code:11510-4098
Practice Address - Country:US
Practice Address - Phone:516-623-4580
Practice Address - Fax:516-623-4588
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-19
Last Update Date:2022-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty