Healthcare Provider Details

I. General information

NPI: 1700718079
Provider Name (Legal Business Name): JACQUELYN ELIZABETH BERMAN DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2026
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 CLARKSON AVE
BROOKLYN NY
11203-2012
US

IV. Provider business mailing address

250 E 25TH ST APT 6F
NEW YORK NY
10010-3280
US

V. Phone/Fax

Practice location:
  • Phone: 718-270-1984
  • Fax:
Mailing address:
  • Phone: 917-829-0797
  • 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: