Provider Demographics
NPI:1821114943
Name:RONNY BERGMAN DC PC
Entity Type:Organization
Organization Name:RONNY BERGMAN DC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RONNY
Authorized Official - Middle Name:
Authorized Official - Last Name:BERGMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:516-944-4300
Mailing Address - Street 1:405 MAIN ST
Mailing Address - Street 2:#4
Mailing Address - City:PORT WASHINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11050-3135
Mailing Address - Country:US
Mailing Address - Phone:516-944-4300
Mailing Address - Fax:
Practice Address - Street 1:405 MAIN ST
Practice Address - Street 2:#4
Practice Address - City:PORT WASHINGTON
Practice Address - State:NY
Practice Address - Zip Code:11050-3135
Practice Address - Country:US
Practice Address - Phone:516-944-4300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-21
Last Update Date:2014-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYXCWTR1Medicare ID - Type Unspecified