Healthcare Provider Details

I. General information

NPI: 1326182346
Provider Name (Legal Business Name): BERGEN FAMILY FOOT CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/16/2007
Last Update Date: 11/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

67 BROADWAY
ELMWOOD PARK NJ
07407-1836
US

IV. Provider business mailing address

67 BROADWAY
ELMWOOD PARK NJ
07407
US

V. Phone/Fax

Practice location:
  • Phone: 201-794-3223
  • Fax: 201-794-8411
Mailing address:
  • Phone: 201-794-3223
  • Fax: 201-794-8411

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberMD02533
License Number StateNJ

VIII. Authorized Official

Name: DR. JOHN JOSEPH CAPONIGRO
Title or Position: OWNER
Credential: DPM
Phone: 201-794-3223