Provider Demographics
NPI:1225024417
Name:ADELBERG, JONATHAN MICHAEL (MD)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:MICHAEL
Last Name:ADELBERG
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 1:3405 NW FEDERAL HWY
Mailing Address - Street 2:
Mailing Address - City:JENSEN BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:34957-4439
Mailing Address - Country:US
Mailing Address - Phone:772-692-8082
Mailing Address - Fax:772-232-9211
Practice Address - Street 1:3405 NW FEDERAL HWY
Practice Address - Street 2:
Practice Address - City:JENSEN BEACH
Practice Address - State:FL
Practice Address - Zip Code:34957-4439
Practice Address - Country:US
Practice Address - Phone:177-269-2808
Practice Address - Fax:772-692-8082
Is Sole Proprietor?:No
Enumeration Date:2005-09-22
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL68270207P00000X
FLME68270207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL251436200Medicaid
FLA341433561770OtherDRIVER LICENSE
FLA78855Medicare UPIN
FL28942WMedicare ID - Type Unspecified