Provider Demographics
NPI:1972631398
Name:BERGER-JENKINS, EVELYN (MD)
Entity Type:Individual
Prefix:DR
First Name:EVELYN
Middle Name:
Last Name:BERGER-JENKINS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:EVELYN
Other - Middle Name:
Other - Last Name:BERGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:250 FORT WASHINGTON AVE
Mailing Address - Street 2:APARTMENT #4B
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10032-1329
Mailing Address - Country:US
Mailing Address - Phone:212-740-1846
Mailing Address - Fax:
Practice Address - Street 1:1 GUSTAVE L LEVY PL
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10029-6500
Practice Address - Country:US
Practice Address - Phone:212-241-1910
Practice Address - Fax:212-241-8738
Is Sole Proprietor?:No
Enumeration Date:2007-02-28
Last Update Date:2012-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY225397208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics