Provider Demographics
NPI:1114988110
Name:BREGMAN, BERTIE MICHAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:BERTIE
Middle Name:MICHAEL
Last Name:BREGMAN
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 1:300 W 108TH ST
Mailing Address - Street 2:APARTMENT 13B
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10025-2757
Mailing Address - Country:US
Mailing Address - Phone:646-245-4448
Mailing Address - Fax:646-682-9758
Practice Address - Street 1:535 W 110TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10025-2086
Practice Address - Country:US
Practice Address - Phone:646-764-0025
Practice Address - Fax:646-682-9758
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY213539207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP2176972OtherOXFORD PROVIDER NUMBER
NY6780709-002OtherCIGNA PROVIDER NUMBER
NY213539-A52OtherHEALTHFIRST PROVIDER NUMB
NY98444OtherAETNA PROVIDER NUMBER
NY22V951Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER
NY98444OtherAETNA PROVIDER NUMBER