NPIMap

Organization Active NPI

New Berlin Family Practice

  • Family Nurse Practitioner
  • New Berlin, NY
National Provider Identifier
1003869066
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
Legal business name
NEW BERLIN FAMILY PRACTICE
Practice address
4 Terrace HTS
New Berlin, NY 13411-9514
Phone
(607) 847-6750
NPI assigned
May 18, 2006
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Roger J. Halbert
Title
Ceo
Phone
(607) 847-7000

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X NU Primary

Addresses

Primary practice location

4 Terrace HTS
New Berlin, NY 13411-9514

Mailing address

PO Box 250
4 Terrace Heights
New Berlin, NY 13411-0250

Other identifiers 1

IdentifierTypeStateIssuer
02160938MedicaidNY

National Provider Directory

National Provider Directory

Locations

4 Terrace Hts
New Berlin, NY 13411
Phone (607) 847-6750

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1147910400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1003869066",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 250",
            "address_2": "4 TERRACE HEIGHTS",
            "city": "NEW BERLIN",
            "state": "NY",
            "postal_code": "134110250"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4 TERRACE HTS",
            "city": "NEW BERLIN",
            "state": "NY",
            "postal_code": "134119514",
            "telephone_number": "607-847-6750"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NEW BERLIN FAMILY PRACTICE",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-18",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "HALBERT",
        "authorized_official_first_name": "ROGER",
        "authorized_official_middle_name": "J.",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "607-847-7000"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02160938",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in New Berlin, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.