Provider Demographics
NPI:1689789471
Name:BERRIOS, MIRIAM TRINIDAD (MD)
Entity Type:Individual
Prefix:DR
First Name:MIRIAM
Middle Name:TRINIDAD
Last Name:BERRIOS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:MIRIAM
Other - Middle Name:TRINIDAD
Other - Last Name:CODDOU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2400 JOHNSON AVE
Mailing Address - Street 2:APT.8 C
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10463-6464
Mailing Address - Country:US
Mailing Address - Phone:718-549-0201
Mailing Address - Fax:
Practice Address - Street 1:3600 JEROME AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10467-1052
Practice Address - Country:US
Practice Address - Phone:718-881-7600
Practice Address - Fax:718-515-8057
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1604172084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry