Provider Demographics
NPI:1720147606
Name:BERRY HILL MEDICAL ASSOCIATES, MD PC
Entity type:Organization
Organization Name:BERRY HILL MEDICAL ASSOCIATES, MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:J
Authorized Official - Last Name:NELSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-922-6546
Mailing Address - Street 1:898 OYSTER BAY RD
Mailing Address - Street 2:A
Mailing Address - City:EAST NORWICH
Mailing Address - State:NY
Mailing Address - Zip Code:11732-1051
Mailing Address - Country:US
Mailing Address - Phone:516-922-6546
Mailing Address - Fax:516-922-6811
Practice Address - Street 1:898 OYSTER BAY RD
Practice Address - Street 2:A
Practice Address - City:EAST NORWICH
Practice Address - State:NY
Practice Address - Zip Code:11732-1051
Practice Address - Country:US
Practice Address - Phone:516-922-6546
Practice Address - Fax:516-922-6811
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-07
Last Update Date:2008-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY125202261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00425416Medicaid
NYC07955Medicare UPIN
NY00425416Medicaid
WYPYR1Medicare PIN