MEDICARE: DR. JONAH S. BERGMAN OD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	TUV006223	NY

General Provider Information

NPI Number	:	1356439624
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JONAH S. BERGMAN OD

Provider Business Mailing Address
First Line	:	205 E 64TH ST STE 101
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10065-6673
Country	:	US
Telephone Number	:	212-888-4000
Fax Number	:	212-888-4151

Provider Business Practice Location Address
First Line	:	205 E 64TH ST STE 101
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10065-6673
Country	:	US
Telephone Number	:	212-888-4000
Fax Number	:	212-888-4151

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/11/2006
Last Update Date	:	02/06/2019

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