Individual
KENNETH M BERRY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
9002 QUEENS BLVD, ELMHURST, NY 11373-4941
(718) 558-1000
Mailing address
407 AIRPORT EXECUTIVE PARK, NANUET, NY 10954-5288
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
168383
NY
207P00000X
Emergency Medicine Physician
Primary
MD039776L
PA
207Q00000X
Family Medicine Physician
168383
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11890666
CAQH
PA
Enumeration date
08/14/2006
Last updated
11/15/2011
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