Healthcare Provider Details

I. General information

NPI: 1568726891
Provider Name (Legal Business Name): JESSICA ZG BERENSON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JESSICA ZOLT-GILBURNE MD

II. Dates (important events)

Enumeration Date: 07/02/2012
Last Update Date: 05/05/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5721 S MARYLAND AVE # 8016K155 COMER CHILDREN'S HOSPITAL
CHICAGO IL
60637-1425
US

IV. Provider business mailing address

180 HARVESTER DR SUITE 110
BURR RIDGE IL
60527-7594
US

V. Phone/Fax

Practice location:
  • Phone: 773-702-7553
  • Fax: 773-834-0748
Mailing address:
  • Phone: 773-702-1150
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0116024655
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License Number036.140566
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: