Provider Demographics
NPI:1114062700
Name:BERGIN, MARY C (NP)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:C
Last Name:BERGIN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:61 W GLEN AVE
Mailing Address - Street 2:
Mailing Address - City:PARAMUS
Mailing Address - State:NJ
Mailing Address - Zip Code:07652-2335
Mailing Address - Country:US
Mailing Address - Phone:201-444-0992
Mailing Address - Fax:
Practice Address - Street 1:1114 GOFFLE RD
Practice Address - Street 2:
Practice Address - City:HAWTHORNE
Practice Address - State:NJ
Practice Address - Zip Code:07506-2014
Practice Address - Country:US
Practice Address - Phone:973-427-7676
Practice Address - Fax:973-427-7476
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2013-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NN07211000363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health