MEDICARE: NORTH BERGEN PEDIATRICS

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	MA06599400	NJ

General Provider Information

NPI Number	:	1942546106
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTH BERGEN PEDIATRICS

Provider Business Mailing Address
First Line	:	2811 KENNEDY BLVD
Second Line	:
City	:	NORTH BERGEN
State	:	NJ
Zip	:	07047-2227
Country	:	US
Telephone Number	:	973-458-8000
Fax Number	:	973-458-8425

Provider Business Practice Location Address
First Line	:	2811 KENNEDY BLVD
Second Line	:
City	:	NORTH BERGEN
State	:	NJ
Zip	:	07047-2227
Country	:	US
Telephone Number	:	973-458-8000
Fax Number	:	973-458-8425

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. RAUL ALMANZAR
Credential	:	M.D.
Telephone Number	:	973-458-8000

Provider Enumeration Date	:	12/17/2012
Last Update Date	:	12/17/2012

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