Provider Demographics
NPI:1568528453
Name:BERARDINO, ANGELA MARIA (GERIATRIC NURSE PRAC)
Entity Type:Individual
Prefix:MS
First Name:ANGELA
Middle Name:MARIA
Last Name:BERARDINO
Suffix:
Gender:F
Credentials:GERIATRIC NURSE PRAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:170 BURNS ST
Mailing Address - Street 2:
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375
Mailing Address - Country:US
Mailing Address - Phone:718-263-2219
Mailing Address - Fax:
Practice Address - Street 1:921 EAST NEW YORK AVE
Practice Address - Street 2:
Practice Address - City:BKLYN
Practice Address - State:NY
Practice Address - Zip Code:11203-1309
Practice Address - Country:US
Practice Address - Phone:718-778-8587
Practice Address - Fax:718-735-8938
Is Sole Proprietor?:No
Enumeration Date:2006-12-28
Last Update Date:2011-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY273442163W00000X
NYF3404341363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
S97129Medicare UPIN
NY93N441Medicare ID - Type Unspecified