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General NPI Number Information
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NPI Number | 1043176159
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Entity Type | Individual
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Provider Name | KAITLYN BERGEN
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Gender | Female
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Dates
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Enumeration Date | 01/02/2026
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Last Update Date | 01/02/2026
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Provider Practice Location Address
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Address Line | 89A VILLAGE CENTER DR
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City | FREEHOLD
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State | NJ
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Zip | 07728-2526
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Country | US
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Telephone | 973-804-6515
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Fax |
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Provider Business Mailing Address
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Address Line | 6 ROONEY CT
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City | MILLSTONE TOWNSHIP
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State | NJ
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Zip | 08510-9413
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 40QA02385100
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License Number State | NJ
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