Basic Information
| Provider Information | |||||||||
| NPI: | 1043869522 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BERGERON-PARENT | ||||||||
| FirstName: | CAMILLE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 43 W 68TH ST APT 1B | ||||||||
| Address2: | |||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100235348 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 690 AMSTERDAM AVE | ||||||||
| Address2: | |||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100256901 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2128654104 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/08/2019 | ||||||||
| LastUpdateDate: | 09/08/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 300621 | NY | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.