1114988110 NPI number — DR. BERTIE MICHAEL BREGMAN M.D.

Table of content: (NPI 1790704005)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114988110 NPI number — DR. BERTIE MICHAEL BREGMAN M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BREGMAN
Provider First Name:
BERTIE
Provider Middle Name:
MICHAEL
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1114988110
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/27/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
300 W 108TH ST
Provider Second Line Business Mailing Address:
APARTMENT 13B
Provider Business Mailing Address City Name:
NEW YORK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10025-2757
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
646-245-4448
Provider Business Mailing Address Fax Number:
646-682-9758

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
535 W 110TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEW YORK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10025-2086
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
646-764-0025
Provider Business Practice Location Address Fax Number:
646-682-9758
Provider Enumeration Date:
03/29/2006

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: 207Q00000X , with the licence number:  213539 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207Q00000X , with the licence number: 25MA11671800 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: P2176972 . This is a "OXFORD PROVIDER NUMBER" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 213539-A52 . This is a "HEALTHFIRST PROVIDER NUMB" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 98444 . This is a "AETNA PROVIDER NUMBER" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 6780709-002 . This is a "CIGNA PROVIDER NUMBER" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com