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NPI Code Detail

MEDICARE: BERGEN ORTHOPEDICS, INC.

MEDICARE: BERGEN ORTHOPEDICS, INC.
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
1335E00000XProsthetic/Orthotic SupplierORT 87FL
2335E00000XProsthetic/Orthotic SupplierORT 88FL

General Provider Information

NPI Number : 1063413946
Entity Type Code : Organization
Provider Name (Legal Business Name) : BERGEN ORTHOPEDICS, INC.
Provider Business Mailing Address
First Line : 4620 NW 7TH ST
Second Line :
City : MIAMI
State : FL
Zip : 33126-2309
Country : US
Telephone Number : 305-774-7608
Fax Number : 305-774-7600
Provider Business Practice Location Address
First Line : 4620 NW 7TH ST
Second Line :
City : MIAMI
State : FL
Zip : 33126-2309
Country : US
Telephone Number : 305-774-7608
Fax Number : 305-774-7600
Authorized Official
Title or Position : PRESIDENT/ LICENSED ORTHOTIST
Name : MS. ROSARIO VICTORIA CARRAZANA
Credential : LO
Telephone Number : 305-774-7608
Provider Enumeration Date : 08/02/2005
Last Update Date : 08/22/2020

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Directions to “BERGEN ORTHOPEDICS, INC. ” Practice Location

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