Individual
BERGSON LOUIS-JACQUES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OTR/L
Contact information
Practice address
1607 ROUTE 300, SUITE 102, NEWBURGH, NY 12550-1738
(845) 564-9853
(845) 564-6974
Mailing address
1607 ROUTE 300, SUITE 102, NEWBURGH, NY 12550-1738
(845) 564-9853
(845) 564-6974
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
011502-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
WEP 441
MEDICARE ID NUMBER
NY
Enumeration date
09/25/2006
Last updated
07/08/2007
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