MEDICARE: MRS. DANA ANN BERGIN DPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	034390	NY
2	225100000X	Physical Therapist	40QA01337600	NJ

General Provider Information

NPI Number	:	1538497037
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. DANA ANN BERGIN DPT

Provider Business Mailing Address
First Line	:	475 NORTHERN BLVD STE 37
Second Line	:
City	:	GREAT NECK
State	:	NY
Zip	:	11021-4802
Country	:	US
Telephone Number	:	516-344-0023
Fax Number	:	516-466-7723

Provider Business Practice Location Address
First Line	:	700 BROADWAY
Second Line	:
City	:	MASSAPEQUA
State	:	NY
Zip	:	11758-2324
Country	:	US
Telephone Number	:	516-797-7003
Fax Number	:	516-797-7336

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/23/2009
Last Update Date	:	06/08/2026

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