Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RH0003X | Hematology & Oncology | 194810 | NY |
NPI | 1043397839 |
---|---|
Provider Name | Dr. Ivan Bergstein |
First Address | Great Neck, NY 11021-1327 |
Second Address | Great Neck, NY 11021-1327 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/11/2006 |
Last Update Date | 08/07/2007 |