Provider Demographics
NPI:1619231107
Name:BERG HORNER, JAYNE ELLEN (MS/ED)
Entity Type:Individual
Prefix:
First Name:JAYNE
Middle Name:ELLEN
Last Name:BERG HORNER
Suffix:
Gender:F
Credentials:MS/ED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2063 SEAMANS NECK RD
Mailing Address - Street 2:
Mailing Address - City:SEAFORD
Mailing Address - State:NY
Mailing Address - Zip Code:11783-2506
Mailing Address - Country:US
Mailing Address - Phone:516-783-3284
Mailing Address - Fax:
Practice Address - Street 1:2063 SEAMANS NECK RD
Practice Address - Street 2:
Practice Address - City:SEAFORD
Practice Address - State:NY
Practice Address - Zip Code:11783-2506
Practice Address - Country:US
Practice Address - Phone:516-783-3284
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-28
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist