Provider Demographics
NPI:1396193033
Name:NEW BERLIN MEDICAL SERVICES, LLC
Entity Type:Organization
Organization Name:NEW BERLIN MEDICAL SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:DONALD
Authorized Official - Last Name:MATTEUCCI
Authorized Official - Suffix:SR
Authorized Official - Credentials:DPM
Authorized Official - Phone:414-761-0981
Mailing Address - Street 1:8153 S 27TH ST
Mailing Address - Street 2:SUITE 400
Mailing Address - City:FRANKLIN
Mailing Address - State:WI
Mailing Address - Zip Code:53132-9549
Mailing Address - Country:US
Mailing Address - Phone:414-304-5311
Mailing Address - Fax:414-761-1614
Practice Address - Street 1:15324 W BELOIT ROAD
Practice Address - Street 2:
Practice Address - City:NEW BERLIN
Practice Address - State:WI
Practice Address - Zip Code:53151
Practice Address - Country:US
Practice Address - Phone:414-761-0981
Practice Address - Fax:414-761-1614
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-02
Last Update Date:2016-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical