Organization
JACK M. BERGSTEIN M.D. LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JACK M. BERGSTEIN M.D. (OWNER / M.D.)
(814) 968-4427
Entity
Organization
Contact information
Practice address
511 S MAIN ST, SHEFFIELD, PA 16347-2013
(814) 968-4427
(814) 968-9112
Mailing address
511 S MAIN ST, SHEFFIELD, PA 16347-2013
(814) 968-4427
(814) 968-9112
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
MD422547
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1831016
BLUE CROSS BLUE SHIELD
PA
Enumeration date
06/10/2006
Last updated
08/22/2020
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