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General NPI Number Information
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NPI Number | 1881625671
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Entity Type | Organization
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Legal Business Name | JEFFREY A BERENSON MD A PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 07/06/2006
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Last Update Date | 04/14/2008
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Provider Practice Location Address
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Address Line | 45081 LITTLE LAKE STREET
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City | MENDOCINO
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State | CA
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Zip | 95460
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Country | US
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Telephone | 707-937-1055
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Fax | 707-937-1061
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Provider Business Mailing Address
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Address Line | PO BOX 38
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City | MENDOCINO
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State | CA
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Zip | 95460
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Country | US
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Telephone | 707-937-1055
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Fax | 707-937-1061
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Authorized Official
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Title or Position | CEO OWNER
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Name | DR. JEFFREY A BERENSON
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Credential | MD
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Telephone | 707-937-1055
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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