Provider Demographics
NPI:1962469809
Name:BERLINER, RANDALL G (MD)
Entity Type:Individual
Prefix:
First Name:RANDALL
Middle Name:G
Last Name:BERLINER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4234-1 BRONX BLVD
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10466-2801
Mailing Address - Country:US
Mailing Address - Phone:718-515-4347
Mailing Address - Fax:718-653-8641
Practice Address - Street 1:4234-1 BRONX BLVD
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10466-2668
Practice Address - Country:US
Practice Address - Phone:718-515-4347
Practice Address - Fax:718-653-8641
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-26
Last Update Date:2019-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY195905174400000X, 2084P0800X, 2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No174400000XOther Service ProvidersSpecialist
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01638462Medicaid
NY9603726003OtherCIGNA
NY134046855OtherAETNA
NY1279657OtherUNITED HEALT CARE
NY231955OtherMANAGED HEALT NET
NYP623258OtherOXFORD
NY134046855Other1199
NY10599OtherHIP CMO
NY134046855OtherTAX ID#
NY0H1338OtherHEALTHNET OF THE NORTHEAS
NYRB0476N110OtherBC/BS
NY195905OtherHIP
NY500151Medicare ID - Type Unspecified
NY134046855OtherAETNA