MEDICARE: BERGEN HEART CENTER, PC

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
1	174400000X	Specialist	25MA04252600	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	7794956	OTHER	NJ	AETNA PPO GROUP#
2	1599845	OTHER	NJ	AETNA HMO GROUP#
3	2864697000	OTHER	NJ	AMERIHEALTH GROUP#

General Provider Information

NPI Number	:	1073727483
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BERGEN HEART CENTER, PC

Provider Business Mailing Address
First Line	:	85 CHESTNUT RIDGE RD
Second Line	:	SUITE 11
City	:	MONTVALE
State	:	NJ
Zip	:	07645-1827
Country	:	US
Telephone Number	:	201-444-9913
Fax Number	:	201-844-6158

Provider Business Practice Location Address
First Line	:	85 CHESTNUT RIDGE RD
Second Line	:	SUITE 11
City	:	MONTVALE
State	:	NJ
Zip	:	07645-1827
Country	:	US
Telephone Number	:	201-444-9913
Fax Number	:	201-844-6158

Authorized Official
Title or Position	:	DELEGATED OFFICIAL
Name	:	PERMINDER GREWAL
Credential	:	M.D.
Telephone Number	:	201-444-9913

Provider Enumeration Date	:	05/09/2007
Last Update Date	:	03/05/2010

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Directions to “BERGEN HEART CENTER, PC ” Practice Location

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