Provider Demographics
NPI:1508048356
Name:DR. ANDREW M. BERLINER
Entity Type:Organization
Organization Name:DR. ANDREW M. BERLINER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PODIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:MARK
Authorized Official - Last Name:BERLINER
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:860-669-1320
Mailing Address - Street 1:246 EAST MAIN STREET
Mailing Address - Street 2:SUITE 2
Mailing Address - City:CLINTON
Mailing Address - State:CT
Mailing Address - Zip Code:06413
Mailing Address - Country:US
Mailing Address - Phone:860-669-1320
Mailing Address - Fax:860-669-5186
Practice Address - Street 1:246 EAST MAIN STREET
Practice Address - Street 2:SUITE 2
Practice Address - City:CLINTON
Practice Address - State:CT
Practice Address - Zip Code:06413
Practice Address - Country:US
Practice Address - Phone:860-669-1320
Practice Address - Fax:860-669-5186
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-04
Last Update Date:2010-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTP00012CT213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004006680Medicaid
CT004006680Medicaid
CT4966360001Medicare NSC
CTT23054Medicare UPIN