Provider Demographics
NPI:1285660209
Name:BERRY, BRENDA L (MD)
Entity Type:Individual
Prefix:DR
First Name:BRENDA
Middle Name:L
Last Name:BERRY
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 1:5676 RIVERDALE AVE
Mailing Address - Street 2:RIVERDALE MHC
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10471-2138
Mailing Address - Country:US
Mailing Address - Phone:718-796-5300
Mailing Address - Fax:
Practice Address - Street 1:5676 RIVERDALE AVE
Practice Address - Street 2:RIVERDALE MHC
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10471-2138
Practice Address - Country:US
Practice Address - Phone:718-796-5300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1596432084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYE83961Medicare UPIN