Healthcare Provider Details

I. General information

NPI: 1346710977
Provider Name (Legal Business Name): ARI J BERGWERK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/27/2018
Last Update Date: 11/27/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

APT #4B 305 RIVERSIDE DRIVE
NEW YORK NY
10025
US

IV. Provider business mailing address

APT #4B 305 RIVERSIDE DRIVE
NEW YORK NY
10025
US

V. Phone/Fax

Practice location:
  • Phone: 310-341-4190
  • Fax:
Mailing address:
  • Phone: 310-341-4190
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0206X
TaxonomyPediatric Gastroenterology Physician
License NumberG083636
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: