Jean R Berggren, M.D.

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

License

232569 Issued in NY

Practice address

300 Wright Avenue
Marcy, NY 13404

Phone

(315) 736-8271

NPI assigned

Jun 5, 2007

Last updated

Jun 1, 2012By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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

{
    "created_epoch": "1181001600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1338508800000",
    "number": "1760684351",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "308 S WINOOSKI AVE APT 2",
            "city": "BURLINGTON",
            "state": "VT",
            "postal_code": "054014591"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 WRIGHT AVENUE",
            "city": "MARCY",
            "state": "NY",
            "postal_code": "13404",
            "telephone_number": "315-736-8271"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BERGGREN",
        "first_name": "JEAN",
        "middle_name": "R",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-06-05",
        "last_updated": "2012-06-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "NY",
            "license": "232569",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "232569",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kimberly Ann Adams
• Maria Adams, RN
• Lorenz Santos Angeles, PSYD
• Vedad Bakalovic
• Diane S Baynon
• George A Bottoni, RPH
• Denise Bulak
• Anne D Burgess, PTA
• Jorge Ernesto Castillo, M.D.
• Central New York Psychiatric Center for Forensics

• Psychiatry Physician in Marcy, NY
• Providers in Marcy, NY by specialty
• Psychiatry Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 1, 2012; 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.