Provider Demographics
NPI:1063468577
Name:BORNSTEIN, JEREMY ELIJAH (PHD)
Entity Type:Individual
Prefix:DR
First Name:JEREMY
Middle Name:ELIJAH
Last Name:BORNSTEIN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 225044
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94122-5044
Mailing Address - Country:US
Mailing Address - Phone:415-449-6440
Mailing Address - Fax:415-449-6440
Practice Address - Street 1:2340 CLAY ST
Practice Address - Street 2:7TH FLOOR
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94115-1932
Practice Address - Country:US
Practice Address - Phone:415-449-6440
Practice Address - Fax:415-449-6440
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 20633103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist