Provider Demographics
NPI:1790844900
Name:DR JAY B BERKOWITZ DC PC
Entity Type:Organization
Organization Name:DR JAY B BERKOWITZ DC 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:B
Authorized Official - Last Name:BERKOWITZ
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:757-497-1555
Mailing Address - Street 1:4867 BAXTER RD
Mailing Address - Street 2:SUITE 107
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23462-4469
Mailing Address - Country:US
Mailing Address - Phone:757-497-1555
Mailing Address - Fax:757-497-2715
Practice Address - Street 1:4867 BAXTER RD
Practice Address - Street 2:SUITE 107
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23462-4469
Practice Address - Country:US
Practice Address - Phone:757-497-1555
Practice Address - Fax:757-497-2715
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-06
Last Update Date:2022-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104000609261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010144175Medicaid
VA350000144Medicare ID - Type Unspecified
VA010144175Medicaid