Healthcare Provider Details

I. General information

NPI: 1104861848
Provider Name (Legal Business Name): JONATHAN BENDER BERZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2006
Last Update Date: 05/03/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

725 ALBANY ST SHAPIRO 5, SUITE B
BOSTON MA
02118-2526
US

IV. Provider business mailing address

720 HARRISON AVE DOB 503
BOSTON MA
02118
US

V. Phone/Fax

Practice location:
  • Phone: 617-414-5951
  • Fax: 617-414-1577
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License Number224197
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number224197
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: