Provider Demographics
NPI:1679770366
Name:BERGMAN, BENJAMIN R (MD)
Entity Type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:R
Last Name:BERGMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:222 HIGH ST
Mailing Address - Street 2:SUITE 205
Mailing Address - City:NEWTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07860-9604
Mailing Address - Country:US
Mailing Address - Phone:973-579-2100
Mailing Address - Fax:973-579-6638
Practice Address - Street 1:222 HIGH ST
Practice Address - Street 2:SUITE 205
Practice Address - City:NEWTON
Practice Address - State:NJ
Practice Address - Zip Code:07860-9604
Practice Address - Country:US
Practice Address - Phone:973-579-2100
Practice Address - Fax:973-579-6638
Is Sole Proprietor?:No
Enumeration Date:2007-06-27
Last Update Date:2013-02-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA09046400207RC0000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0303992Medicaid
P01086189OtherRAILROAD MEDICARE
NJ243382CNWMedicare PIN