Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YS0123X | Facial Plastic Surgeon | 167019 | NY |
NPI | 1679512727 |
---|---|
Provider Name | Dr. Michael J Bergstein |
First Address | Tarrytown, NY 10591-5139 |
Second Address | Sleepy Hollow, NY 10591-2322 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/06/2006 |
Last Update Date | 24/01/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E50380 | (02) | NY |