Provider Demographics
NPI:1790707859
Name:JUSINO-BERRIOS, CARLOS MANUEL (MD)
Entity Type:Individual
Prefix:DR
First Name:CARLOS
Middle Name:MANUEL
Last Name:JUSINO-BERRIOS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:651 ACADEMY ST
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10034-5003
Mailing Address - Country:US
Mailing Address - Phone:212-942-0043
Mailing Address - Fax:
Practice Address - Street 1:651 ACADEMY ST
Practice Address - Street 2:2ND FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10034-5003
Practice Address - Country:US
Practice Address - Phone:212-942-0043
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2011-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1575432084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA63688Medicare UPIN
NY499BP1Medicare ID - Type Unspecified