Provider Demographics
NPI:1174663652
Name:BERRYHILL, ROY STUART JR (RPA-C)
Entity type:Individual
Prefix:MR
First Name:ROY
Middle Name:STUART
Last Name:BERRYHILL
Suffix:JR
Gender:M
Credentials:RPA-C
Other - Prefix:
Other - First Name:CHIP
Other - Middle Name:
Other - Last Name:BERRYHILL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RPA-C
Mailing Address - Street 1:436 E 69TH ST
Mailing Address - Street 2:APARTMENT 6L
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-5643
Mailing Address - Country:US
Mailing Address - Phone:212-706-0776
Mailing Address - Fax:
Practice Address - Street 1:525 E 68TH ST
Practice Address - Street 2:STARR 900
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-4870
Practice Address - Country:US
Practice Address - Phone:212-746-5638
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011344363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant