Provider Demographics
NPI:1053493437
Name:BROOKLYN COLLEGE SPEECH AND HEARING CENTER
Entity Type:Organization
Organization Name:BROOKLYN COLLEGE SPEECH AND HEARING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:BERGEN
Authorized Official - Suffix:
Authorized Official - Credentials:AUD
Authorized Official - Phone:718-951-5186
Mailing Address - Street 1:2900 BEDFORD AVE
Mailing Address - Street 2:4400 BOYLAN HALL
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11210-2850
Mailing Address - Country:US
Mailing Address - Phone:718-951-5186
Mailing Address - Fax:718-951-4363
Practice Address - Street 1:2900 BEDFORD AVE
Practice Address - Street 2:4400 BOYLAN HALL
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11210-2850
Practice Address - Country:US
Practice Address - Phone:718-951-5186
Practice Address - Fax:718-951-4363
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000609-1231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYM71401Medicare ID - Type UnspecifiedAUDIOLOGIST
NYM0W091Medicare ID - Type UnspecifiedBC SPEECH & HEARING CENTE