Individual
JOHN R. BERGIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
315 S MANNING BLVD, ST PETER'S HOSPITAL, ALBANY, NY 12208-1707
(518) 525-1550
Mailing address
315 S MANNING BLVD, ST PETER'S HOSPITAL, ALBANY, NY 12208-1707
(518) 525-1550
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
000476
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000496464003
BLUE SHIELD
NY
01
—
050316000062
FIDELIS
NY
01
—
384107
MVP
NY
Enumeration date
05/18/2006
Last updated
02/12/2010
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