Provider Demographics
NPI:1033123823
Name:BERGIN, GAIL MARIE (FNP)
Entity Type:Individual
Prefix:
First Name:GAIL
Middle Name:MARIE
Last Name:BERGIN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1225 MORRIS PARK AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10461-1929
Mailing Address - Country:US
Mailing Address - Phone:718-430-0038
Mailing Address - Fax:718-839-7212
Practice Address - Street 1:1225 MORRIS PARK AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461-1929
Practice Address - Country:US
Practice Address - Phone:718-430-0038
Practice Address - Fax:718-839-7212
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2023-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF332513363LF0000X
NJNN097771363LF0000X
NJ26NR09777100363LF0000X
NYF400675363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8447802Medicaid
NJ038716Medicare PIN
NJ8447802Medicaid
NJP84816Medicare UPIN
NJ153932N57Medicare Oscar/Certification
NJ153932N57Medicare PIN
NJ049217Medicare PIN