Provider Demographics
NPI:1912195488
Name:BRIAN A BERELOWITZ MD APC
Entity Type:Organization
Organization Name:BRIAN A BERELOWITZ MD APC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:ALBERT
Authorized Official - Last Name:BERELOWITZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:702-804-9486
Mailing Address - Street 1:653 N TOWN CENTER DR
Mailing Address - Street 2:SUITE 315
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89144-0514
Mailing Address - Country:US
Mailing Address - Phone:702-804-9486
Mailing Address - Fax:702-938-0441
Practice Address - Street 1:653 N TOWN CENTER DR
Practice Address - Street 2:SUITE 315
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89144-0514
Practice Address - Country:US
Practice Address - Phone:702-804-9486
Practice Address - Fax:702-938-0441
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-10
Last Update Date:2007-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV5954174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV002002877Medicaid
NVC43987Medicare UPIN
NV002002877Medicaid