Provider Demographics
NPI:1174623367
Name:BERLIN, LEONARD ARTHUR (DO)
Entity type:Individual
Prefix:DR
First Name:LEONARD
Middle Name:ARTHUR
Last Name:BERLIN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:180 GREAT NECK ROAD
Mailing Address - Street 2:
Mailing Address - City:COPIAGUE
Mailing Address - State:NY
Mailing Address - Zip Code:11726
Mailing Address - Country:US
Mailing Address - Phone:631-842-0770
Mailing Address - Fax:631-842-6105
Practice Address - Street 1:180 GREAT NECK ROAD
Practice Address - Street 2:
Practice Address - City:COPIAGUE
Practice Address - State:NY
Practice Address - Zip Code:11726
Practice Address - Country:US
Practice Address - Phone:631-842-0770
Practice Address - Fax:631-842-6105
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY121933D207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
D33364Medicare UPIN
342181Medicare ID - Type Unspecified