Provider Demographics
NPI:1164599122
Name:BERLYNE, SUZANNAH DEBORAH (MD)
Entity Type:Individual
Prefix:DR
First Name:SUZANNAH
Middle Name:DEBORAH
Last Name:BERLYNE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:200 RIVERSIDE BLVD
Mailing Address - Street 2:APT 20 D
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10069-0901
Mailing Address - Country:US
Mailing Address - Phone:212-579-3838
Mailing Address - Fax:212-579-3838
Practice Address - Street 1:125 OCEANA DR E
Practice Address - Street 2:APT 3H
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-6691
Practice Address - Country:US
Practice Address - Phone:917-532-7352
Practice Address - Fax:917-677-4812
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2010-03-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY197128207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02011549Medicaid
NY56N671Medicare ID - Type Unspecified
NYG89608Medicare UPIN