Healthcare Provider Details

I. General information

NPI: 1326969601
Provider Name (Legal Business Name): ELLA SUSANNE BERGMAN DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/23/2026
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 MIDDLETON ST
BROOKLYN NY
11206-5415
US

IV. Provider business mailing address

121 W 19TH ST APT 8E
NEW YORK NY
10011-4135
US

V. Phone/Fax

Practice location:
  • Phone: 718-303-9400
  • Fax:
Mailing address:
  • Phone: 541-206-7585
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number055952
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: