Organization
ISLAND SOUTH CHIROPRACTIC PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JUSTIN L BERGIN DC (OWNER)
(718) 966-7000
Entity
Organization
Contact information
Practice address
91 FOSTER RD, STATEN ISLAND, NY 10309
(718) 966-7000
(718) 317-7452
Mailing address
91 FOSTER RD, STATEN ISLAND, NY 10309
(718) 966-7000
(718) 317-7452
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
X010715NY
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
7929464
AETNA
NY
01
—
P2952873
OXFORD
NJ
01
—
P2952873
OXFORD
NY
Enumeration date
03/02/2007
Last updated
08/22/2020
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