Provider Demographics
NPI:1063512002
Name:BERGMAN, MARK J (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:J
Last Name:BERGMAN
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Gender:M
Credentials:MD
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Mailing Address - Street 1:175 E MAIN ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:HUNTINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11743-2939
Mailing Address - Country:US
Mailing Address - Phone:631-549-5700
Mailing Address - Fax:631-549-1991
Practice Address - Street 1:175 E MAIN ST
Practice Address - Street 2:SUITE 200
Practice Address - City:HUNTINGTON
Practice Address - State:NY
Practice Address - Zip Code:11743-2939
Practice Address - Country:US
Practice Address - Phone:631-549-5700
Practice Address - Fax:631-549-1991
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2008-04-25
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Provider Licenses
StateLicense IDTaxonomies
NY150032207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
060003596Medicare PIN
NY28D660Z691Medicare PIN