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NPI Code Detail

MEDICARE: BERGEN P.T. ASSOCIATES, LLC

MEDICARE: BERGEN P.T. ASSOCIATES, LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261QP2000XPhysical Therapy Clinic/Center40QA00296600NJ

General Provider Information

NPI Number : 1013075654
Entity Type Code : Organization
Provider Name (Legal Business Name) : BERGEN P.T. ASSOCIATES, LLC
Provider Business Mailing Address
First Line : 495 BOULEVARD
Second Line : UNIT 4
City : ELMWOOD PARK
State : NJ
Zip : 07407-2041
Country : US
Telephone Number : 201-370-7195
Fax Number :
Provider Business Practice Location Address
First Line : 495 BOULEVARD
Second Line : UNIT 4
City : ELMWOOD PARK
State : NJ
Zip : 07407-2041
Country : US
Telephone Number : 201-370-7195
Fax Number :
Authorized Official
Title or Position : OWNER
Name : DR. HOWARD JAMES PHILLIPS
Credential : PT, PHD OCS, FAAOMPT
Telephone Number : 201-370-7195
Provider Enumeration Date : 12/05/2006
Last Update Date : 08/22/2020

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