Healthcare Provider Details

I. General information

NPI: 1447457403
Provider Name (Legal Business Name): BERGEN GASTROENTEROLOGY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/02/2007
Last Update Date: 08/20/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

466 OLD HOOK RD SUITE 1
EMERSON NJ
07630-1396
US

IV. Provider business mailing address

466 OLD HOOK RD SUITE 1
EMERSON NJ
07630-1396
US

V. Phone/Fax

Practice location:
  • Phone: 201-967-8221
  • Fax: 201-634-9647
Mailing address:
  • Phone: 201-967-8221
  • Fax: 201-634-9647

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number308228
License Number StateNJ

VIII. Authorized Official

Name: MRS. BARBARA ECKERT
Title or Position: BILLING MANAGER
Credential:
Phone: 201-967-2455