Active NPI
Susan Beris, M.D.
- Pediatrics Physician
- Southbury, CT
National Provider Identifier
1083620900
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- 031080
- Practice address
- 22 Old Waterbury Rd # 204
Southbury, CT 06488-3848 - Phone
- (203) 262-4250
- NPI assigned
- Jul 31, 2006
- Last updated
- Aug 17, 2016
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 031080 | CT | Primary |
Addresses
Primary practice location
22 Old Waterbury Rd # 204
Southbury, CT 06488-3848
Mailing address
22 Old Waterbury Rd # 204
Southbury, CT 06488-3848
Phone (203) 262-4250
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 031080 | CT | MD | Pediatrics Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1154304000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1471392000000",
"number": "1083620900",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "22 OLD WATERBURY RD # 204",
"city": "SOUTHBURY",
"state": "CT",
"postal_code": "064883848",
"telephone_number": "203-262-4250"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "22 OLD WATERBURY RD # 204",
"city": "SOUTHBURY",
"state": "CT",
"postal_code": "064883848",
"telephone_number": "203-262-4250"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BERIS",
"first_name": "SUSAN",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-07-31",
"last_updated": "2016-08-17",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "CT",
"license": "031080",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Southbury, CT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 17, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.