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General NPI Number Information
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NPI Number | 1982645768
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Entity Type | Organization
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Legal Business Name | JACK M. BERGSTEIN M.D. LLC
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Dates
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Enumeration Date | 06/10/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 511 S MAIN ST
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City | SHEFFIELD
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State | PA
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Zip | 16347-2013
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Country | US
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Telephone | 814-968-4427
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Fax | 814-968-9112
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Provider Business Mailing Address
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Address Line | 511 S MAIN ST
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City | SHEFFIELD
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State | PA
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Zip | 16347-2013
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Country | US
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Telephone | 814-968-4427
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Fax | 814-968-9112
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Authorized Official
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Title or Position | OWNER / M.D.
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Name | DR. JACK M. BERGSTEIN
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Credential | M.D.
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Telephone | 814-968-4427
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | MD422547
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License Number State | PA
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