Healthcare Provider Details

I. General information

NPI: 1770436149
Provider Name (Legal Business Name): JARED BIRNBERG
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/17/2026
Last Update Date: 02/17/2026
Certification Date: 02/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1208 EASTCHESTER DR
HIGH POINT NC
27265-3170
US

IV. Provider business mailing address

4825 BILTMORE FOREST DR
MATTHEWS NC
28105-2856
US

V. Phone/Fax

Practice location:
  • Phone: 336-878-6644
  • Fax:
Mailing address:
  • Phone: 704-441-6440
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: