Provider Demographics
NPI:1982903449
Name:BERLINER, JACQUELINE GOULART (MD)
Entity Type:Individual
Prefix:DR
First Name:JACQUELINE
Middle Name:GOULART
Last Name:BERLINER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:JACQUELINE
Other - Middle Name:MARIE
Other - Last Name:GOULART
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:20 E ELM ST
Mailing Address - Street 2:
Mailing Address - City:GREENWICH
Mailing Address - State:CT
Mailing Address - Zip Code:06830-6529
Mailing Address - Country:US
Mailing Address - Phone:203-764-2230
Mailing Address - Fax:
Practice Address - Street 1:20 E ELM ST
Practice Address - Street 2:
Practice Address - City:GREENWICH
Practice Address - State:CT
Practice Address - Zip Code:06830-6529
Practice Address - Country:US
Practice Address - Phone:203-764-2230
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-23
Last Update Date:2021-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY283512207NS0135X, 207ND0101X
CT65009207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
No207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery