Provider Demographics
NPI:1871622431
Name:BERGIN, JUSTIN L (DC)
Entity type:Individual
Prefix:DR
First Name:JUSTIN
Middle Name:L
Last Name:BERGIN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 GORDONS CORNER RD STE 2G
Mailing Address - Street 2:
Mailing Address - City:MANALAPAN
Mailing Address - State:NJ
Mailing Address - Zip Code:07726-3342
Mailing Address - Country:US
Mailing Address - Phone:732-446-7400
Mailing Address - Fax:732-446-6119
Practice Address - Street 1:225 GORDONS CORNER RD STE 2G
Practice Address - Street 2:
Practice Address - City:MANALAPAN
Practice Address - State:NJ
Practice Address - Zip Code:07726-3342
Practice Address - Country:US
Practice Address - Phone:347-236-1092
Practice Address - Fax:718-317-7452
Is Sole Proprietor?:No
Enumeration Date:2007-03-02
Last Update Date:2020-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00637000111N00000X, 111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY7929464OtherAETNA
NJP2952873OtherOXFORD
NYP2952873OtherOXFORD
NJP2952873OtherOXFORD
NYX6G741Medicare ID - Type Unspecified