Provider Demographics
NPI:1679671242
Name:BERRIDGE, PATRICIA LEE (DC)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:LEE
Last Name:BERRIDGE
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1184 HEMPSTEAD TPKE
Mailing Address - Street 2:
Mailing Address - City:UNIONDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11553-1240
Mailing Address - Country:US
Mailing Address - Phone:516-538-5522
Mailing Address - Fax:516-538-5531
Practice Address - Street 1:1184 HEMPSTEAD TPKE
Practice Address - Street 2:
Practice Address - City:UNIONDALE
Practice Address - State:NY
Practice Address - Zip Code:11553-1240
Practice Address - Country:US
Practice Address - Phone:516-538-5522
Practice Address - Fax:516-538-5531
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2011-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX001967-1111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYX12011Medicare ID - Type Unspecified