Provider Demographics
NPI:1679618300
Name:BERLIN, EILEEN C (RN)
Entity type:Individual
Prefix:
First Name:EILEEN
Middle Name:C
Last Name:BERLIN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:64 PHILA ST APT 4
Mailing Address - Street 2:
Mailing Address - City:SARATOGA SPRINGS
Mailing Address - State:NY
Mailing Address - Zip Code:12866-3259
Mailing Address - Country:US
Mailing Address - Phone:518-581-7043
Mailing Address - Fax:
Practice Address - Street 1:12 PETRA LN
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12205-4973
Practice Address - Country:US
Practice Address - Phone:518-452-0445
Practice Address - Fax:518-452-3489
Is Sole Proprietor?:No
Enumeration Date:2007-02-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY406851-1163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY406851-1OtherRN LICENSE