Provider Demographics
NPI:1972765220
Name:MONTELEONE, BERRIN (MD)
Entity Type:Individual
Prefix:DR
First Name:BERRIN
Middle Name:
Last Name:MONTELEONE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 MINEOLA BLVD STE 210
Mailing Address - Street 2:
Mailing Address - City:MINEOLA
Mailing Address - State:NY
Mailing Address - Zip Code:11501-4077
Mailing Address - Country:US
Mailing Address - Phone:516-663-4600
Mailing Address - Fax:516-663-8296
Practice Address - Street 1:120 MINEOLA BLVD STE 210
Practice Address - Street 2:
Practice Address - City:MINEOLA
Practice Address - State:NY
Practice Address - Zip Code:11501-4077
Practice Address - Country:US
Practice Address - Phone:516-663-4600
Practice Address - Fax:516-663-8296
Is Sole Proprietor?:No
Enumeration Date:2008-06-27
Last Update Date:2022-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200800870207SG0201X
NY253183207SG0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207SG0201XAllopathic & Osteopathic PhysiciansMedical GeneticsClinical Genetics (M.D.)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1972765220Medicaid
SCQ0087RMedicaid
SCQ0087RMedicaid