Lisa Bergenbaum

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

729978131 Issued in NY

Practice address

9130 Metropolitan Ave
Forest Hills, NY 11375-6671

Phone

(718) 286-4700

NPI assigned

Feb 18, 2014

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1392681600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1634688000000",
    "number": "1134543754",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "32 NEEDLE LN",
            "city": "LEVITTOWN",
            "state": "NY",
            "postal_code": "117564829",
            "telephone_number": "516-313-9901"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9130 METROPOLITAN AVE",
            "city": "FOREST HILLS",
            "state": "NY",
            "postal_code": "113756671",
            "telephone_number": "718-286-4700"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "7000 Austin St Ste 200",
            "address_purpose": "LOCATION",
            "city": "Forest Hills",
            "state": "NY",
            "postal_code": "113754739",
            "country_code": "US",
            "telephone_number": "718-762-7633",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BERGENBAUM",
        "first_name": "LISA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2014-02-18",
        "last_updated": "2021-10-20",
        "certification_date": "2021-10-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "NY",
            "license": "729978131",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jeta Bera, PHARMD
• Christina Berdebes, PHD, LMFT
• Cherrylene Abulag Berdos Ruba, PT
• Dara Bergen, RD
• Robert Bergen, LCSW
• Alexander Berger, CASAC
• Chani Berger, R - P.A., CERTIFIED
• Natalya Beria
• Revaz Beridze, DDS
• Otto Michael Berk, LCSW

• Speech-Language Pathologist in Forest Hills, NY
• Providers in Forest Hills, NY by specialty
• Speech-Language Pathologist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 20, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.