Provider Demographics
NPI:1780896530
Name:BERLIN, DENA (CPNP)
Entity type:Individual
Prefix:MS
First Name:DENA
Middle Name:
Last Name:BERLIN
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:263 7TH AVE STE 4A
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11215-3693
Mailing Address - Country:US
Mailing Address - Phone:718-246-8590
Mailing Address - Fax:718-246-8592
Practice Address - Street 1:263 7TH AVE STE 4A
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11215-3693
Practice Address - Country:US
Practice Address - Phone:718-246-8590
Practice Address - Fax:718-246-8592
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-04
Last Update Date:2017-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY381880363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0327684Medicaid