Doctor Name: | MISS NICHOLE MARIE BERGIN |
NPI Number: | 1033553060 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LMT |
License Number: | 025947 |
Business Practice Address: | 175 Route 304 Bardonia, NY - 109542042 |
Business Phone Number: | 8455070477 |
Business Fax Number: | 8455070490 |
Mailing Address: | 7 Brookhill Dr, WEST NYACK |
State: | NY |
Postal Code: | 109942101 |
Phone Number: | 8454804432 |
Fax Number: | |
NPI Enumeration Date: | 04/21/2013 |
NPI Last Update Date: | 04/21/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 225700000X |
License Number: | 025947 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NY |
Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
Taxonomy Classification: | Massage Therapist |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual trained in the manipulation of tissues (as by rubbing, stroking, kneading, or tapping) with the hand or an instrument for remedial or hygienic purposes. |