Provider Demographics
NPI:1639856388
Name:BERGSTOL, DOROTHY MARIE
Entity Type:Individual
Prefix:
First Name:DOROTHY
Middle Name:MARIE
Last Name:BERGSTOL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 REID AVE
Mailing Address - Street 2:
Mailing Address - City:BREEZY POINT
Mailing Address - State:NY
Mailing Address - Zip Code:11697-1219
Mailing Address - Country:US
Mailing Address - Phone:347-425-6878
Mailing Address - Fax:
Practice Address - Street 1:10 REID AVE
Practice Address - Street 2:
Practice Address - City:BREEZY POINT
Practice Address - State:NY
Practice Address - Zip Code:11697-1219
Practice Address - Country:US
Practice Address - Phone:347-425-6878
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-03
Last Update Date:2023-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency