Provider Demographics
NPI:1790829364
Name:B & R PODIATRY
Entity Type:Organization
Organization Name:B & R PODIATRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER-PODIATRIST
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:J
Authorized Official - Last Name:BERKOWITZ
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:440-735-3338
Mailing Address - Street 1:28790 CHAGRIN BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:WOODMERE
Mailing Address - State:OH
Mailing Address - Zip Code:44122
Mailing Address - Country:US
Mailing Address - Phone:216-831-3338
Mailing Address - Fax:440-735-8234
Practice Address - Street 1:28790 CHAGRIN BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:WOODMERE
Practice Address - State:OH
Practice Address - Zip Code:44122
Practice Address - Country:US
Practice Address - Phone:216-831-3338
Practice Address - Fax:440-735-8234
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-16
Last Update Date:2010-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2306213E00000X
OH36001803B213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2182794Medicaid
OH0358849Medicaid
OH2182794Medicaid
OH0358849Medicaid
OHT80482Medicare UPIN
OH3023000001Medicare NSC