Provider Demographics
NPI:1710982327
Name:BERLINER, ANDREW MARK (DPM)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:MARK
Last Name:BERLINER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 LIBERTY VILLAGE
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:CT
Mailing Address - Zip Code:06413
Mailing Address - Country:US
Mailing Address - Phone:860-669-4304
Mailing Address - Fax:
Practice Address - Street 1:246 E MAIN ST
Practice Address - Street 2:SUITE 2
Practice Address - City:CLINTON
Practice Address - State:CT
Practice Address - Zip Code:06413-2245
Practice Address - Country:US
Practice Address - Phone:860-669-1320
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-20
Last Update Date:2010-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTP00012213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT480000241OtherMEDICARE PROVIDER NUMBER
CT004006680Medicaid
CT4966360001Medicare NSC
CTT23054Medicare UPIN