Provider Demographics
NPI:1922159490
Name:MOUNT KISCO FOOT SPECIALISTS, PLLC
Entity Type:Organization
Organization Name:MOUNT KISCO FOOT SPECIALISTS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:BERLINER
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:914-666-7367
Mailing Address - Street 1:344 E MAIN ST STE 206
Mailing Address - Street 2:
Mailing Address - City:MOUNT KISCO
Mailing Address - State:NY
Mailing Address - Zip Code:10549-3036
Mailing Address - Country:US
Mailing Address - Phone:914-666-7367
Mailing Address - Fax:914-666-7416
Practice Address - Street 1:344 E MAIN ST STE 206
Practice Address - Street 2:
Practice Address - City:MOUNT KISCO
Practice Address - State:NY
Practice Address - Zip Code:10549-3036
Practice Address - Country:US
Practice Address - Phone:914-666-7367
Practice Address - Fax:914-666-7416
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-13
Last Update Date:2019-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN005062213E00000X
NYN005061213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1176780001Medicare NSC