MEDICARE: DR. JAY BERKOWITZ MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	028024	CT

General Provider Information

NPI Number	:	1255382396
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAY BERKOWITZ MD

Provider Business Mailing Address
First Line	:	52 BEACH RD
Second Line	:	SUITE 104
City	:	FAIRFIELD
State	:	CT
Zip	:	06824-6017
Country	:	US
Telephone Number	:	203-254-2000
Fax Number	:	203-255-3126

Provider Business Practice Location Address
First Line	:	52 BEACH RD
Second Line	:	SUITE 104
City	:	FAIRFIELD
State	:	CT
Zip	:	06824-6017
Country	:	US
Telephone Number	:	203-254-2000
Fax Number	:	203-255-3126

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/13/2006
Last Update Date	:	09/17/2010

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