Bergstein, Jack M.

Bergstein, Jack M. is an sole proprietor health care provider with primary practice located at 7205 54Th Pl Ne Unit A , Marysville WA 98270-8932. He recently has 2 registered licenses in different health care specialties including Other Service Providers / Specialist, Allopathic & Osteopathic Physicians / Surgery. Allopathic & Osteopathic Physicians / Surgery is his primary health care specialty. Bergstein, Jack M. can be contacted via phone (724) 833-2171.

Contact Information

Primary practice address
7205 54Th Pl Ne Unit A Marysville WA 98270-8932
Phone: (724) 833-2171
Fax: (360) 386-8019
Website:
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Health care specialties

SpecialtyCodeLicense #State
Other Service Providers / Specialist 174400000X MD422547 Pennsylvania
Allopathic & Osteopathic Physicians / Surgery 208600000X MD60641501 Washington

Profile Details

NPI number 1154366300
LBN Legal business name Bergstein, Jack M.
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Jun 19th, 2006
Last updated Mar 17th, 2018 - about 8 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1154366300 NPPES
Pennsylvania Other 1548575 BLUE CROSS BLUE SHIELD
Pennsylvania MEDICAID 0012111170005 BLUE CROSS BLUE SHIELD
Pennsylvania Other 147447 BLUE CROSS BLUE SHIELD
Pennsylvania Other 305022 BLUE CROSS BLUE SHIELD
Pennsylvania Other 00026626302 BLUE CROSS BLUE SHIELD

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