Provider Demographics
NPI:1194702589
Name:BERMAN, JONAH BERNARD (OD)
Entity type:Individual
Prefix:
First Name:JONAH
Middle Name:BERNARD
Last Name:BERMAN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 EAST 33 STREET
Mailing Address - Street 2:#15 P
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016
Mailing Address - Country:US
Mailing Address - Phone:917-539-3510
Mailing Address - Fax:
Practice Address - Street 1:328 E 34TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-4922
Practice Address - Country:US
Practice Address - Phone:212-581-2020
Practice Address - Fax:212-581-2021
Is Sole Proprietor?:No
Enumeration Date:2005-12-27
Last Update Date:2012-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV005815152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01718556Medicaid
NY01718556Medicaid
NYC26641Medicare ID - Type Unspecified