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NPI Code Detail

MEDICARE: ANDREW S BERGMAN PA-C

MEDICARE: ANDREW S BERGMAN PA-C
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
12255A2300XAthletic Trainer25MT00155300NJ
2363AS0400XSurgical Physician Assistant
3363A00000XPhysician Assistant25MP00481600NJ

General Provider Information

NPI Number : 1528499555
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANDREW S BERGMAN PA-C
Provider Business Mailing Address
First Line : 301 LIPPINCOTT DR STE 410
Second Line :
City : MARLTON
State : NJ
Zip : 08053-4197
Country : US
Telephone Number : 856-355-0340
Fax Number :
Provider Business Practice Location Address
First Line : 131 ROUTE 70 STE 100A
Second Line :
City : MEDFORD
State : NJ
Zip : 08055-9501
Country : US
Telephone Number : 609-267-9400
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/02/2013
Last Update Date : 11/27/2023

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Directions to “ ANDREW S BERGMAN PA-C” Practice Location

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