Basic Information
| Provider Information | |||||||||
| NPI: | 1265579932 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BERGER | ||||||||
| FirstName: | JONATHAN | ||||||||
| MiddleName: | CARLIN | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 740 S LIMESTONE | ||||||||
| Address2: | SUITE K 301 | ||||||||
| City: | LEXINGTON | ||||||||
| State: | KY | ||||||||
| PostalCode: | 405360284 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8593234661 | ||||||||
| FaxNumber: | 8592573644 | ||||||||
| Practice Location | |||||||||
| Address1: | 403 E 34TH ST FL 3 | ||||||||
| Address2: | |||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100164907 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2122633605 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/31/2007 | ||||||||
| LastUpdateDate: | 10/20/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/20/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 204F00000X | 48466 | KY | N | Allopathic & Osteopathic Physicians | Transplant Surgery | 208600000X | 4301102547 | MI | N | Allopathic & Osteopathic Physicians | Surgery | 208600000X | NA | MD | N | Allopathic & Osteopathic Physicians | Surgery | 204F00000X | 301667 | NY | Y | Allopathic & Osteopathic Physicians | Transplant Surgery |
No ID Information.