Provider Demographics
NPI:1922393818
Name:ALINA BERGAN DDS PC
Entity Type:Organization
Organization Name:ALINA BERGAN DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALINA
Authorized Official - Middle Name:
Authorized Official - Last Name:BERGAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:516-374-2882
Mailing Address - Street 1:650 CENTRAL AVE
Mailing Address - Street 2:SUITE F
Mailing Address - City:CEDARHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11516-2301
Mailing Address - Country:US
Mailing Address - Phone:516-374-2882
Mailing Address - Fax:516-374-2886
Practice Address - Street 1:650 CENTRAL AVE
Practice Address - Street 2:SUITE F
Practice Address - City:CEDARHURST
Practice Address - State:NY
Practice Address - Zip Code:11516-2301
Practice Address - Country:US
Practice Address - Phone:516-374-2882
Practice Address - Fax:516-374-2886
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-19
Last Update Date:2011-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0521011223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02718129Medicaid