Provider Demographics
NPI:1063511665
Name:BERMAN, JEROME (MD)
Entity Type:Individual
Prefix:
First Name:JEROME
Middle Name:
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 1:188 04 NORTHERN BLVD
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11358-2811
Mailing Address - Country:US
Mailing Address - Phone:718-445-1090
Mailing Address - Fax:
Practice Address - Street 1:188 04 NORTHERN BLVD
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11358-2811
Practice Address - Country:US
Practice Address - Phone:718-445-1090
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2010-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY112385207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY441181102OtherRAILROAD MEDICARE
NY00203452Medicaid
NY112385A48OtherHEALTH FIRST
NY0012626OtherGHI
NY0C1099OtherHEALTH NET
NY608064OtherAETNA
NYDS526OtherOXFORD
NYP61159096OtherMULTIPLAN
NY973471OtherBLUE CROSS BLUE SHIELD
NY973471OtherBLUE CROSS BLUE SHIELD
NY12626Medicare PIN