Provider Demographics
NPI:1679610703
Name:GARY T. BERGSTEIN
Entity Type:Organization
Organization Name:GARY T. BERGSTEIN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:T
Authorized Official - Last Name:BERGSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:412-781-4433
Mailing Address - Street 1:701 FREEPORT ROAD
Mailing Address - Street 2:
Mailing Address - City:SHARPSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15215
Mailing Address - Country:US
Mailing Address - Phone:412-781-4433
Mailing Address - Fax:412-781-9208
Practice Address - Street 1:701 FREEPORT ROAD
Practice Address - Street 2:
Practice Address - City:SHARPSBURG
Practice Address - State:PA
Practice Address - Zip Code:15215
Practice Address - Country:US
Practice Address - Phone:412-781-4433
Practice Address - Fax:412-781-9208
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC003337L111N00000X
PADC007699L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA01887575Medicaid
PA1084257Medicaid
PA072811LPNMedicare ID - Type UnspecifiedGARY T. BERGSTEIN
PAU78889Medicare UPIN
PA01887575Medicaid
PA1084257Medicaid