Provider Demographics
NPI:1376793976
Name:BERG, JONATHAN IAN (MD)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:IAN
Last Name:BERG
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Gender:M
Credentials:MD
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Mailing Address - Street 1:20 GRAND STREET
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:WARWICK
Mailing Address - State:NY
Mailing Address - Zip Code:10990-1035
Mailing Address - Country:US
Mailing Address - Phone:845-353-5600
Mailing Address - Fax:845-987-5979
Practice Address - Street 1:2 CROSFIELD AVENUE
Practice Address - Street 2:SUITE 318
Practice Address - City:WEST NYACK
Practice Address - State:NY
Practice Address - Zip Code:10994
Practice Address - Country:US
Practice Address - Phone:845-353-5600
Practice Address - Fax:845-353-5668
Is Sole Proprietor?:No
Enumeration Date:2008-09-19
Last Update Date:2019-01-02
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Provider Licenses
StateLicense IDTaxonomies
NY241687207R00000X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine