Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 104100000X | Social Worker | 092522 | NY |
NPI | 1003216532 |
---|---|
Provider Name | Peter Bergman |
First Address | New York, NY 10019-6113 |
Second Address | New York, NY 10019-6113 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/09/2014 |
Last Update Date | 03/09/2014 |