Provider Demographics
NPI:1932169307
Name:BERLIN, IRINA (MD)
Entity Type:Individual
Prefix:
First Name:IRINA
Middle Name:
Last Name:BERLIN
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 1:2785 W 5TH ST
Mailing Address - Street 2:#23E
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11224-4629
Mailing Address - Country:US
Mailing Address - Phone:718-627-8300
Mailing Address - Fax:718-627-8302
Practice Address - Street 1:40 W BRIGHTON AVE
Practice Address - Street 2:SUITE # 104
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11224-4902
Practice Address - Country:US
Practice Address - Phone:718-627-8300
Practice Address - Fax:718-627-8302
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-28
Last Update Date:2013-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY211765207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02318858Medicaid
NY02318858Medicaid
3V5402Medicare ID - Type Unspecified