Provider Demographics
NPI:1255769246
Name:PIERRE, JEAN BERLONGE (MD)
Entity type:Individual
Prefix:
First Name:JEAN
Middle Name:BERLONGE
Last Name:PIERRE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2412 N STATE ROAD 7
Mailing Address - Street 2:
Mailing Address - City:LAUDERDALE LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33313-3724
Mailing Address - Country:US
Mailing Address - Phone:954-289-0000
Mailing Address - Fax:888-365-3056
Practice Address - Street 1:2412 N STATE ROAD 7
Practice Address - Street 2:
Practice Address - City:LAUDERDALE LAKES
Practice Address - State:FL
Practice Address - Zip Code:33313-3724
Practice Address - Country:US
Practice Address - Phone:954-289-0000
Practice Address - Fax:888-365-3056
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-29
Last Update Date:2024-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR18580208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice