Provider Demographics
NPI:1356496228
Name:JAY B BERGER MD PC
Entity Type:Organization
Organization Name:JAY B BERGER MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAY
Authorized Official - Middle Name:BENNETT
Authorized Official - Last Name:BERGER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:610-865-3570
Mailing Address - Street 1:77 W BROAD ST
Mailing Address - Street 2:UNIT 14-C
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18018-5751
Mailing Address - Country:US
Mailing Address - Phone:610-865-3570
Mailing Address - Fax:610-865-2581
Practice Address - Street 1:77 W BROAD ST
Practice Address - Street 2:UNIT 14-C
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18018-5751
Practice Address - Country:US
Practice Address - Phone:610-865-3570
Practice Address - Fax:610-865-2581
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-24
Last Update Date:2010-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
03181200OtherCAPITAL BLUE CROSS
PA000639429Medicaid
000019375OtherHIGHMARK BLUE SHIELD
0050616001OtherIBC HMO
111908532OtherPALMETTO GBA-RR MEDICARE
0004669929OtherAETNA
20028934OtherAMHP
20028934OtherAMHP
BE019375Medicare ID - Type Unspecified