Provider Demographics
NPI:1982039707
Name:BERGMANN, GARY ANDREW (LPN)
Entity Type:Individual
Prefix:MR
First Name:GARY
Middle Name:ANDREW
Last Name:BERGMANN
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 BELLHAVEN RD
Mailing Address - Street 2:
Mailing Address - City:BELLPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11713-2815
Mailing Address - Country:US
Mailing Address - Phone:516-557-8128
Mailing Address - Fax:
Practice Address - Street 1:26 BELLHAVEN RD
Practice Address - Street 2:
Practice Address - City:BELLPORT
Practice Address - State:NY
Practice Address - Zip Code:11713-2815
Practice Address - Country:US
Practice Address - Phone:516-557-8128
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-11
Last Update Date:2014-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY193269164W00000X
NY193269 DUP164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse