Provider Demographics
NPI:1184620502
Name:BERGMANN, PATRICK PAUL (MS,CCC)
Entity type:Individual
Prefix:MR
First Name:PATRICK
Middle Name:PAUL
Last Name:BERGMANN
Suffix:
Gender:M
Credentials:MS,CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:48 THOMPSON HILL RD.
Mailing Address - Street 2:
Mailing Address - City:RENSSELAER
Mailing Address - State:NY
Mailing Address - Zip Code:12144
Mailing Address - Country:US
Mailing Address - Phone:518-943-0591
Mailing Address - Fax:518-943-0591
Practice Address - Street 1:9 W SAND LAKE RD
Practice Address - Street 2:
Practice Address - City:WYNANTSKILL
Practice Address - State:NY
Practice Address - Zip Code:12198-7954
Practice Address - Country:US
Practice Address - Phone:518-690-2060
Practice Address - Fax:518-690-7111
Is Sole Proprietor?:No
Enumeration Date:2005-06-21
Last Update Date:2022-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002039231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY10102164OtherCDPHP
NY50802000004OtherFIDELAS
NY4899688OtherGHI-PPO
NY10102164OtherCDPHP
NYRA7621Medicare ID - Type UnspecifiedMEDICARE