Provider Demographics
NPI:1316031362
Name:BERGMAN, RONNY (DC)
Entity Type:Individual
Prefix:DR
First Name:RONNY
Middle Name:
Last Name:BERGMAN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:405 MAIN ST
Mailing Address - Street 2:#4
Mailing Address - City:PORT WASHINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11050-3135
Mailing Address - Country:US
Mailing Address - Phone:516-944-4300
Mailing Address - Fax:516-944-4301
Practice Address - Street 1:405 MAIN ST
Practice Address - Street 2:#4
Practice Address - City:PORT WASHINGTON
Practice Address - State:NY
Practice Address - Zip Code:11050-3135
Practice Address - Country:US
Practice Address - Phone:516-944-4300
Practice Address - Fax:516-944-4301
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2010-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX010090111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYX04R71OtherEMPIRE BLUE CROSS BLUE SH
NYU86890OtherUNITED HEALTHCARE
NYP2537073OtherOXFORD
NYU86890OtherUNITED HEALTHCARE