1538497037 NPI number — MRS. DANA ANN BERGIN DPT

Table of content: MRS. DANA ANN BERGIN DPT (NPI 1538497037)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538497037 NPI number — MRS. DANA ANN BERGIN DPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BERGIN
Provider First Name:
DANA
Provider Middle Name:
ANN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
DPT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CAUDA
Provider Other First Name:
DANA
Provider Other Middle Name:
ANN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
DPT
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1538497037
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/22/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PROGRESSIVE PHYSICAL THERAPY, PC
Provider Second Line Business Mailing Address:
700 BROADWAY
Provider Business Mailing Address City Name:
MASSAPEQUA
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11758-6621
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
516-797-7003
Provider Business Mailing Address Fax Number:
516-797-7336

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
PROGRESSIVE PHYSICAL THERAPY, PC
Provider Second Line Business Practice Location Address:
700 BROADWAY
Provider Business Practice Location Address City Name:
MASSAPEQUA
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11758-6621
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
516-797-7003
Provider Business Practice Location Address Fax Number:
516-797-7336
Provider Enumeration Date:
11/23/2009

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: 225100000X , with the licence number:  40QA01337600 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225100000X , with the licence number: 034390 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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