Basic Information
| Provider Information | |||||||||
| NPI: | 1184620502 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BERGMANN | ||||||||
| FirstName: | PATRICK | ||||||||
| MiddleName: | PAUL | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MS,CCC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 48 THOMPSON HILL RD. | ||||||||
| Address2: | |||||||||
| City: | RENSSELAER | ||||||||
| State: | NY | ||||||||
| PostalCode: | 12144 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5189430591 | ||||||||
| FaxNumber: | 5189430591 | ||||||||
| Practice Location | |||||||||
| Address1: | 9 W SAND LAKE RD | ||||||||
| Address2: | |||||||||
| City: | WYNANTSKILL | ||||||||
| State: | NY | ||||||||
| PostalCode: | 121987954 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5186902060 | ||||||||
| FaxNumber: | 5186907111 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/21/2005 | ||||||||
| LastUpdateDate: | 01/26/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/26/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 231H00000X | 002039 | NY | Y | Speech, Language and Hearing Service Providers | Audiologist |
ID Information
| ID | Type | State | Issuer | Description | 10102164 | 01 | NY | CDPHP | OTHER | 50802000004 | 01 | NY | FIDELAS | OTHER | 4899688 | 01 | NY | GHI-PPO | OTHER |