Provider Demographics
NPI:1437213881
Name:BERRIO, ROYCE DAYMONN (CO)
Entity Type:Individual
Prefix:MR
First Name:ROYCE
Middle Name:DAYMONN
Last Name:BERRIO
Suffix:
Gender:M
Credentials:CO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:481 BUNKER DR
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11572-5633
Mailing Address - Country:US
Mailing Address - Phone:516-594-6902
Mailing Address - Fax:
Practice Address - Street 1:18515 UNION TPKE
Practice Address - Street 2:
Practice Address - City:FRESH MEADOWS
Practice Address - State:NY
Practice Address - Zip Code:11366-1731
Practice Address - Country:US
Practice Address - Phone:718-264-9800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ45PO00003500174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01063914Medicaid
NY01063914Medicaid