Provider Demographics
NPI:1043316490
Name:BERMAN, JONATHAN ROSS (MD)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:ROSS
Last Name:BERMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:670 GLADES RD
Mailing Address - Street 2:240
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33431-6461
Mailing Address - Country:US
Mailing Address - Phone:561-417-0171
Mailing Address - Fax:561-417-2023
Practice Address - Street 1:670 GLADES RD
Practice Address - Street 2:240
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33431-6461
Practice Address - Country:US
Practice Address - Phone:561-470-0171
Practice Address - Fax:561-417-2023
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-15
Last Update Date:2014-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0057530174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist