Provider Demographics
NPI:1952311946
Name:RICHARD S. BERRY MDPC
Entity Type:Organization
Organization Name:RICHARD S. BERRY MDPC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:BERRY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-996-3000
Mailing Address - Street 1:2820 OCEAN PKWY
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-7958
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2820 OCEAN PKWY
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-7958
Practice Address - Country:US
Practice Address - Phone:718-996-3000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-09
Last Update Date:2008-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY124011174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY124011OtherHIP
NY4095409OtherAETNA
NY00233096Medicaid
NY0033804OtherGHI
NY308920101OtherHEALTHPLUW
NY973731OtherBLUE CROSS & BLUE SHIELD
NY90436OtherAETNA
NY161917OtherELDERPLAN
NYMCA058903OtherAMERICHOICE
NY124011-A18OtherHEALTHFIRST
NY4C3563OtherHEALTHNET
NYDS086OtherOXFORD
NY308920101OtherHEALTHPLUW
NY4C3563OtherHEALTHNET
NY=========OtherMULTIPLAN
NY973731OtherBLUE CROSS & BLUE SHIELD
NY161917OtherELDERPLAN