Provider Demographics
NPI:1326577073
Name:BERGSTEIN, YESHAYE
Entity Type:Individual
Prefix:
First Name:YESHAYE
Middle Name:
Last Name:BERGSTEIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5409 19TH AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11204-1654
Mailing Address - Country:US
Mailing Address - Phone:646-761-9783
Mailing Address - Fax:646-930-7084
Practice Address - Street 1:5409 19TH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11204
Practice Address - Country:US
Practice Address - Phone:646-761-9783
Practice Address - Fax:646-930-7084
Is Sole Proprietor?:No
Enumeration Date:2017-06-07
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY046144263747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY04614426Medicaid