Provider Demographics
NPI:1790853356
Name:BERGMAN, CINDY FAY (08151956)
Entity Type:Individual
Prefix:
First Name:CINDY
Middle Name:FAY
Last Name:BERGMAN
Suffix:
Gender:F
Credentials:08151956
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:185 COW NECK RD
Mailing Address - Street 2:
Mailing Address - City:PORT WASHINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11050-1143
Mailing Address - Country:US
Mailing Address - Phone:516-944-9629
Mailing Address - Fax:
Practice Address - Street 1:191 MAIN ST
Practice Address - Street 2:PORT WASHINGTON HEARING CENTER LLC
Practice Address - City:PORT WASHINGTON
Practice Address - State:NY
Practice Address - Zip Code:11050-3231
Practice Address - Country:US
Practice Address - Phone:516-883-9311
Practice Address - Fax:516-883-3652
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001379-1231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist