Provider Demographics
NPI:1568566552
Name:BERGMAN, IRA M (MD)
Entity Type:Individual
Prefix:DR
First Name:IRA
Middle Name:M
Last Name:BERGMAN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1160 PARK AVE
Mailing Address - Street 2:#1E
Mailing Address - City:NY
Mailing Address - State:NY
Mailing Address - Zip Code:10128
Mailing Address - Country:US
Mailing Address - Phone:212-289-4128
Mailing Address - Fax:212-289-4219
Practice Address - Street 1:1160 PARK AVE
Practice Address - Street 2:#1E
Practice Address - City:NY
Practice Address - State:NY
Practice Address - Zip Code:10128
Practice Address - Country:US
Practice Address - Phone:212-289-4128
Practice Address - Fax:212-289-4219
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-11
Last Update Date:2020-01-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY1686912084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
A62093Medicare UPIN
31E211Medicare ID - Type Unspecified