Healthcare Provider Details

I. General information

NPI: 1801855721
Provider Name (Legal Business Name): JEFFREY BERMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2006
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 TECHNOLOGY DR UNIT C300
TRUMBULL CT
06611-6347
US

IV. Provider business mailing address

2660 MAIN STREET SUITE 216
BRIDGEPORT CT
06606-5301
US

V. Phone/Fax

Practice location:
  • Phone: 203-445-7093
  • Fax: 203-638-7981
Mailing address:
  • Phone: 475-210-3545
  • Fax: 203-581-6509

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number032359
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: