Provider Demographics
NPI:1194782300
Name:BERGMAN, AKIVA (MD)
Entity type:Individual
Prefix:
First Name:AKIVA
Middle Name:
Last Name:BERGMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2315 VICTORY BLVD
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10314-6623
Mailing Address - Country:US
Mailing Address - Phone:718-477-6900
Mailing Address - Fax:718-477-7862
Practice Address - Street 1:2315 VICTORY BLVD
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10314-6623
Practice Address - Country:US
Practice Address - Phone:718-477-6900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-01
Last Update Date:2008-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY237680-1207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1466318OtherAETNA HMO
NY0414218OtherEVERCARE
NY3032S1OtherEMPIRE BCBS
NYBA7680OtherATLANTIS HEALTH PLAN
NY02724972Medicaid
NYP3807648OtherOXFORD
NY185524OtherELDERPLAN
NY237680OtherHIP
NY000000116247OtherGHI HMO
NY7466899OtherAETNA PPO
NY0145892OtherGHI PPO
NY5C8688OtherHEALTHNET
NY1466318OtherAETNA HMO