Healthcare Provider Details

I. General information

NPI: 1245899822
Provider Name (Legal Business Name): HEARWELL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/07/2019
Last Update Date: 01/26/2022
Certification Date: 01/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9 W SAND LAKE RD
WYNANTSKILL NY
12198-7954
US

IV. Provider business mailing address

9 W SAND LAKE RD
WYNANTSKILL NY
12198-7954
US

V. Phone/Fax

Practice location:
  • Phone: 518-326-1742
  • Fax: 518-326-1745
Mailing address:
  • Phone: 518-326-1742
  • Fax: 518-326-1745

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0700X
TaxonomyHearing and Speech Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. PATRICK PAUL BERGMANN
Title or Position: DR. OF AUDIOLOGY
Credential: AUD
Phone: 518-326-1742