Provider Demographics
NPI:1386893691
Name:BERGDOLL, DARLENE
Entity type:Individual
Prefix:
First Name:DARLENE
Middle Name:
Last Name:BERGDOLL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:565 WOODBURY RD
Mailing Address - Street 2:
Mailing Address - City:COLD SPRING HARBOR
Mailing Address - State:NY
Mailing Address - Zip Code:11724-2239
Mailing Address - Country:US
Mailing Address - Phone:631-424-3846
Mailing Address - Fax:
Practice Address - Street 1:565 WOODBURY RD
Practice Address - Street 2:
Practice Address - City:COLD SPRING HARBOR
Practice Address - State:NY
Practice Address - Zip Code:11724-2239
Practice Address - Country:US
Practice Address - Phone:631-424-3846
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-10
Last Update Date:2008-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY225871163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse