Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081P2900X | Pain Medicine | 218436 | NY |
NPI | 1073516332 |
---|---|
Provider Name | Rachel E Bergang |
First Address | New York, NY 10028-4301 |
Second Address | New York, NY 10028 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/05/2005 |
Last Update Date | 30/08/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
02659763 | (05) | NY |
I19270 | (02) | NY |