Provider Demographics
NPI:1003091059
Name:JAY S BERGER MD PA
Entity Type:Organization
Organization Name:JAY S BERGER MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JAY
Authorized Official - Middle Name:S
Authorized Official - Last Name:BERGER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:863-467-1117
Mailing Address - Street 1:1713 HIGHWAY 441 N
Mailing Address - Street 2:SUITE D
Mailing Address - City:OKEECHOBEE
Mailing Address - State:FL
Mailing Address - Zip Code:34972-1900
Mailing Address - Country:US
Mailing Address - Phone:863-467-1117
Mailing Address - Fax:863-467-2775
Practice Address - Street 1:1713 HIGHWAY 441 N
Practice Address - Street 2:SUITE D
Practice Address - City:OKEECHOBEE
Practice Address - State:FL
Practice Address - Zip Code:34972-1900
Practice Address - Country:US
Practice Address - Phone:863-467-1117
Practice Address - Fax:863-467-2775
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-08
Last Update Date:2009-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME46844207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL044218600Medicaid
FL044218600Medicaid
FLD62491Medicare UPIN
FLK3109Medicare PIN