Provider Demographics
NPI:1346536794
Name:CHANLER-BERAT, JORDAN R (MD)
Entity Type:Individual
Prefix:DR
First Name:JORDAN
Middle Name:R
Last Name:CHANLER-BERAT
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 1:1345 RXR PLZ
Mailing Address - Street 2:
Mailing Address - City:UNIONDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11556-1301
Mailing Address - Country:US
Mailing Address - Phone:516-783-4600
Mailing Address - Fax:646-846-3283
Practice Address - Street 1:418-420 5TH AVENUE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11215
Practice Address - Country:US
Practice Address - Phone:516-783-4600
Practice Address - Fax:646-846-3283
Is Sole Proprietor?:No
Enumeration Date:2011-06-23
Last Update Date:2019-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY277185207P00000X
NC2014-01244207P00000X
MA277263207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCNC2168Medicaid
NC1346536794Medicaid
NC1346536794Medicaid