Healthcare Provider Details

I. General information

NPI: 1063706232
Provider Name (Legal Business Name): JONATHAN L BERLINER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2011
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 GREENWICH OFFICE PARK
GREENWICH CT
06831-5151
US

IV. Provider business mailing address

6 GREENWICH OFFICE PARK
GREENWICH CT
06831-5151
US

V. Phone/Fax

Practice location:
  • Phone: 203-869-1145
  • Fax: 203-618-1721
Mailing address:
  • Phone: 203-869-1145
  • Fax: 203-618-1721

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number282607
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number56555
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: