Provider Demographics
NPI:1841314994
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:DR
Authorized Official - First Name:RICAHRD
Authorized Official - Middle Name:S
Authorized Official - Last Name:BERRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-845-1919
Mailing Address - Street 1:8441 149TH AVE
Mailing Address - Street 2:
Mailing Address - City:HOWARD BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11414-1218
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8441 149TH AVE
Practice Address - Street 2:
Practice Address - City:HOWARD BEACH
Practice Address - State:NY
Practice Address - Zip Code:11414-1218
Practice Address - Country:US
Practice Address - Phone:718-845-1919
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-16
Last Update Date:2020-08-22
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
NY124011-A18OtherHEALTHFIRST
NY00233096Medicaid
NY4C3563OtherHEALTHNET
NYMCA058903OtherAMERICHOICE
NY0033804OtherGHI
NY10202678OtherAMERIGROUP
NY161917OtherELDERPLAN
NY4095409OtherAETNA
NY90436OtherAETNA
NY1000055146OtherAFFINITY
NY973731OtherBLUE CROSS & BLUE SHIELD
NYDS086OtherOXFORD
NY622145OtherUNITED HEALTHCARE
NY4C3563OtherHEALTHNET
NY=========OtherMAGNACARE
NY=========Other1199
NY622145OtherUNITED HEALTHCARE
NY973731OtherBLUE CROSS & BLUE SHIELD