MR. PHILIP JACOB BERGEN JR. (NPI# 1235752866) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1235752866 |
| Entity Type | Individual |
| Full Name | MR. PHILIP JACOB BERGEN JR. |
| Credential | PA-C |
| Practice Address |
21 Grand St Hartford CT 06106-1541 |
| Mailing Address |
4 Sky Edge Ln Bethel CT 06801-1023 |
| Practice Telephone | 8605507500 |
| Mailing Telephone | 2039474621 |
| Enumeration Date | 2020-05-18 |
| Last Update Date | 2020-05-18 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363A00000X | Physician Assistant | Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
21 GRAND ST |
| City | HARTFORD |
| State | CT |
| Zip Code | 06106-1541 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1558364653 | Jennifer A Colucci | Nurse Practitioner | 21 Grand St, Hartford, CT 06106-1541 | 2005-05-23 |
| 1518583780 | Ludwig V Rosiclair | Pharmacist | 21 Grand St, Hartford, CT 06106-1541 | 2020-06-23 |
| 1982243580 | Melissa Richardson | Nurse Practitioner | 21 Grand St, Hartford, CT 06106-1541 | 2019-12-30 |
| 1841838596 | Kristal Velazquez | Midwife | 21 Grand St, Hartford, CT 06106-1541 | 2019-12-12 |
| 1346888237 | Jillian Smith | Advanced Practice Midwife | 21 Grand St, Hartford, CT 06106-1541 | 2019-12-11 |
| 1467002634 | Stephanie Marie Watson | Physician Assistant | 21 Grand St, Hartford, CT 06106-1541 | 2019-09-18 |
| 1598311763 | Joeli Mcquaid-robert | Social Worker | 21 Grand St, Hartford, CT 06106-1541 | 2019-08-14 |
| 1487207718 | Andrea Fachini | Physician Assistant | 21 Grand St, Hartford, CT 06106-1541 | 2019-07-16 |
| 1831758366 | Kelly Ruiz | Physician Assistant | 21 Grand St, Hartford, CT 06106-1541 | 2019-06-09 |
| 1174188262 | Samantha Ann Windoloski | Physician Assistant | 21 Grand St, Hartford, CT 06106-1541 | 2019-05-05 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1750907325 | Vartika Kesarwani | Student in an Organized Health Care Education/Training Program | Hartford Hospital Adult Primary Care-brown Stone, 79 Retreat Avenue, Hartford, CT 06106 | 2020-06-19 |
| 1720602865 | Meher Kaur Singha | Student in an Organized Health Care Education/Training Program | Hartford Hospital Adult Primary Care- Brown Stone, 79 Retreat Avenue, Hartford, CT 06106 | 2020-06-04 |
| 1497314140 | Eduardo Mantovani Cardoso | Student in an Organized Health Care Education/Training Program | Hartford Hospital Adut Primary Care - Brown Stone, 79 Retreat Avenue, Hartford, CT 06106 | 2019-06-06 |
| 1114582178 | Dimitrios Drekolias | Student in an Organized Health Care Education/Training Program | Hartford Hospital Adult Primary Care - Brown Stone, 79 Retreat Avenue, Hartford, CT 06106 | 2019-05-06 |
| 1316501687 | Rafae Shaikh | Student in an Organized Health Care Education/Training Program | Hartford Hospital Adult Primary Care Brown Stone, 79 Retreat Avenue, Hartford, CT 06106 | 2019-04-23 |
| 1437643715 | Lucas Bensa | Social Worker | 421 Washington St., Apt C1, Hartford, CT 06106 | 2018-06-19 |
| 1548754310 | Collin Dimler | Physician Assistant | 85 Seymour St Ste 1003, Hartford, CT 06106 | 2018-06-15 |
| 1619460581 | Bryan F Stringer | Student in an Organized Health Care Education/Training Program | 79 Retreat Ave., Hh-adult Primary Care - Brown Stone, Hartford, CT 06106 | 2018-06-14 |
| 1083103972 | Margret Sigurdardottir Blondal | Student in an Organized Health Care Education/Training Program | 282 Washington Street, Ste 4h, Hartford, CT 06106 | 2018-05-07 |
| 1265920995 | Rudra Ramanathan | Student in an Organized Health Care Education/Training Program | 79 Retreat Ave Brown Stone, Hartford, CT 06106 | 2018-04-27 |
| Find all providers in zip 06106 | ||||
| Taxonomy Code | 363A00000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1265961775 | Jessica Cerrato | Physician Assistant | Hartford Hospital Emergency Dept, 80 Seymour Street, Hartford, CT 06102-5037 | 2017-06-08 |
| 1528471687 | Ephraim Wakszul | Physician Assistant | 19 Woodland St Ste 23, Hartford, CT 06105-2368 | 2014-06-06 |
| 1912321183 | Lauren Schmidtberg | Physician Assistant | 282 Washington St # 2l, Hartford, CT 06106-3322 | 2014-02-09 |
| 1710093869 | Tara Breslin | Physician Assistant | 490 Blue Hills Avenue, Mt.sinai Rehabilitation Hospital/ Physician Suite, Hartford, CT 06112-3088 | 2006-08-22 |
| 1760490676 | Jean Anne Mccracken Turcotte | Physician Assistant | 100 Retreat Ave Ste 811, Hartford, CT 06106-2528 | 2006-08-04 |
| 1700809795 | Sanford Clinic | Physician Assistant | 905 N Oaks Ave, Hartford, SD 57033-6358 | 2006-07-25 |
| 1255394904 | Johanna B Cahill | Physician Assistant | 85 Seymour St Ste 719, Hartford, CT 06106-5560 | 2006-04-11 |
| 1730168634 | Tina Robbins | Physician Assistant | 401 New Britain Ave, Hartford, CT 06106 | 2006-01-10 |
| 1225029663 | Christopher J Delgross | Physician Assistant | 114 Woodland Street, Department of Medicine, Hartford, CT 06105 | 2005-11-03 |
| 1568451698 | Shawn Christine Hake | Physician Assistant | 402 W Sumner St, Hartford, WI 53027-1400 | 2005-10-20 |
| Find all providers in HARTFORD | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.