Provider Demographics
NPI:1619345436
Name:BERKS DIABETES MANAGEMENT
Entity Type:Organization
Organization Name:BERKS DIABETES MANAGEMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:MR
Authorized Official - First Name:RALPH
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:CINCINNATI
Authorized Official - Suffix:
Authorized Official - Credentials:CRNP
Authorized Official - Phone:610-927-9815
Mailing Address - Street 1:1030 REED AVE
Mailing Address - Street 2:SUITE 116
Mailing Address - City:WYOMISSING
Mailing Address - State:PA
Mailing Address - Zip Code:19610-2039
Mailing Address - Country:US
Mailing Address - Phone:610-373-7743
Mailing Address - Fax:610-378-9337
Practice Address - Street 1:1030 REED AVE
Practice Address - Street 2:SUITE 116
Practice Address - City:WYOMISSING
Practice Address - State:PA
Practice Address - Zip Code:19610-2039
Practice Address - Country:US
Practice Address - Phone:610-373-7743
Practice Address - Fax:610-378-9337
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-10
Last Update Date:2015-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA207RE0101X
PASP007277363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Multi-Specialty
No207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Multi-Specialty