Provider Demographics
NPI:1669400826
Name:BERKOWITZ-BERLINER, JILL MANDI (DPM)
Entity type:Individual
Prefix:DR
First Name:JILL
Middle Name:MANDI
Last Name:BERKOWITZ-BERLINER
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:344 E MAIN ST STE 206
Mailing Address - Street 2:
Mailing Address - City:MOUNT KISCO
Mailing Address - State:NY
Mailing Address - Zip Code:10549-3036
Mailing Address - Country:US
Mailing Address - Phone:914-666-7367
Mailing Address - Fax:914-666-7416
Practice Address - Street 1:344 E MAIN ST STE 206
Practice Address - Street 2:
Practice Address - City:MOUNT KISCO
Practice Address - State:NY
Practice Address - Zip Code:10549-3036
Practice Address - Country:US
Practice Address - Phone:914-666-7367
Practice Address - Fax:914-666-7416
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2019-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN005061-1213EP1101X, 213ER0200X, 213ES0103X, 213ES0131X, 213E00000X, 213ES0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
No213ER0200XPodiatric Medicine & Surgery Service ProvidersPodiatristRadiology
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
No213ES0000XPodiatric Medicine & Surgery Service ProvidersPodiatristSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01632833Medicaid
NYP60961Medicare ID - Type Unspecified
NY01632833Medicaid