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General NPI Number Information
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NPI Number | 1235752866
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Entity Type | Individual
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Provider Name | PHILIP JACOB BERGEN JR. PA-C
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Gender | Male
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Dates
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Enumeration Date | 05/18/2020
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Last Update Date | 10/30/2025
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Provider Practice Location Address
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Address Line | 60 OLD NEW MILFORD RD STE 3E
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City | BROOKFIELD
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State | CT
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Zip | 06804-2414
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Country | US
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Telephone | 203-775-6205
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Fax |
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Provider Business Mailing Address
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Address Line | 18 TURKEY HILL RD
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City | NEWTOWN
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State | CT
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Zip | 06470-2314
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Country | US
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Telephone | 203-947-4621
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 23.004823
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License Number State | CT
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