Healthcare Provider Details

I. General information

NPI: 1124376181
Provider Name (Legal Business Name): BERGEN TOTAL HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2012
Last Update Date: 05/15/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

135 COUNTY RD STE 2A
CRESSKILL NJ
07626
US

IV. Provider business mailing address

135 COUNTY RD SUITE 2A
CRESSKILL NJ
07626-2203
US

V. Phone/Fax

Practice location:
  • Phone: 201-290-5002
  • Fax: 201-569-0500
Mailing address:
  • Phone: 201-569-0500
  • Fax: 201-569-5561

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111NN0400X
TaxonomyNeurology Chiropractor
License Number38MC00524400
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number26NJ00816800
License Number StateNJ

VIII. Authorized Official

Name: DR. THOMAS CAMPIONE
Title or Position: SOLE MEMBER
Credential: APN-C, D.C.
Phone: 201-569-0500