Provider Demographics
NPI:1942262241
Name:BERLIN, LANCE R (DPM)
Entity Type:Individual
Prefix:DR
First Name:LANCE
Middle Name:R
Last Name:BERLIN
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 1:2330 UNION BLVD
Mailing Address - Street 2:
Mailing Address - City:ISLIP
Mailing Address - State:NY
Mailing Address - Zip Code:11751-3103
Mailing Address - Country:US
Mailing Address - Phone:631-277-8900
Mailing Address - Fax:631-277-0298
Practice Address - Street 1:2330 UNION BLVD
Practice Address - Street 2:
Practice Address - City:ISLIP
Practice Address - State:NY
Practice Address - Zip Code:11751-3103
Practice Address - Country:US
Practice Address - Phone:631-277-8900
Practice Address - Fax:631-277-0298
Is Sole Proprietor?:No
Enumeration Date:2006-04-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN004704-1213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01290248Medicaid
NY01290248Medicaid
NYP53681Medicare ID - Type Unspecified