1508931783 NPI number — MRS. REBECA E. BERGOFSKY I CLINICAL SOCIAL WORK

Table of content: MRS. REBECA E. BERGOFSKY I CLINICAL SOCIAL WORK (NPI 1508931783)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508931783 NPI number — MRS. REBECA E. BERGOFSKY I CLINICAL SOCIAL WORK

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BERGOFSKY
Provider First Name:
REBECA
Provider Middle Name:
E.
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
I
Provider Credential Text:
CLINICAL SOCIAL WORK
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BERGOFSKY
Provider Other First Name:
REBECA
Provider Other Middle Name:
E
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
I
Provider Other Credential Text:
CLINICAL SOCIAL WORK
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1508931783
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
55 CENTRAL PARK WEST
Provider Second Line Business Mailing Address:
10D
Provider Business Mailing Address City Name:
NEW YORK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10023-6003
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
212-579-1184
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
55 CENTRAL PARK W APT 10D
Provider Second Line Business Practice Location Address:
10D
Provider Business Practice Location Address City Name:
NEW YORK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10023-6003
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
212-579-1184
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/22/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  PR001978 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 1041C0700X , with the licence number: PR001978 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

Other Provider's Identifiers (legacy, non-NPI)