Provider Demographics
NPI:1164656724
Name:BERGIN, JACQUELINE (CMT)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:
Last Name:BERGIN
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:FAIR HAVEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07704-3320
Mailing Address - Country:US
Mailing Address - Phone:917-991-6145
Mailing Address - Fax:
Practice Address - Street 1:788 SHREWSBURY AVE
Practice Address - Street 2:
Practice Address - City:TINTON FALLS
Practice Address - State:NJ
Practice Address - Zip Code:07724-3080
Practice Address - Country:US
Practice Address - Phone:732-758-1800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-12
Last Update Date:2009-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor