1962469809 NPI number — RANDALL G BERLINER MD

Table of content: RANDALL G BERLINER MD (NPI 1962469809)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962469809 NPI number — RANDALL G BERLINER MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BERLINER
Provider First Name:
RANDALL
Provider Middle Name:
G
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1962469809
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/24/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4234-1 BRONX BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BRONX
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10466-2801
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-515-4347
Provider Business Mailing Address Fax Number:
718-653-8641

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4234-1 BRONX BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BRONX
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10466-2668
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-515-4347
Provider Business Practice Location Address Fax Number:
718-653-8641
Provider Enumeration Date:
04/26/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  195905 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084P0800X , with the licence number: 195905 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084N0400X , with the licence number: 195905 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 01638462 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 9603726003 . This is a "CIGNA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 134046855 . This is a "AETNA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 1279657 . This is a "UNITED HEALT CARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 231955 . This is a "MANAGED HEALT NET" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: P623258 . This is a "OXFORD" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 134046855 . This is a "1199" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 10599 . This is a "HIP CMO" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 134046855 . This is a "TAX ID#" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 0H1338 . This is a "HEALTHNET OF THE NORTHEAS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: RB0476N110 . This is a "BC/BS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 195905 . This is a "HIP" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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