Healthcare Provider Details

I. General information

NPI: 1689623621
Provider Name (Legal Business Name): PEGGY A SOLOMON-BERGEN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/08/2006
Last Update Date: 06/04/2020
Certification Date: 06/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 ATLANTIC AVE
ATLANTIC CITY NJ
08401-7247
US

IV. Provider business mailing address

1 N WHITE HORSE PIKE
HAMMONTON NJ
08037-1875
US

V. Phone/Fax

Practice location:
  • Phone: 609-572-0000
  • Fax: 609-572-0039
Mailing address:
  • Phone: 609-567-0434
  • Fax: 609-567-1169

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number25MA04422100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: