Provider Demographics
NPI:1629747795
Name:BERKOWITZ, JORDANA
Entity Type:Individual
Prefix:
First Name:JORDANA
Middle Name:
Last Name:BERKOWITZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10505 69TH AVE APT 306
Mailing Address - Street 2:
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-3303
Mailing Address - Country:US
Mailing Address - Phone:347-846-9718
Mailing Address - Fax:
Practice Address - Street 1:10505 69TH AVE APT 306
Practice Address - Street 2:
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-3303
Practice Address - Country:US
Practice Address - Phone:347-846-9718
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-10
Last Update Date:2021-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist