Healthcare Provider Details

I. General information

NPI: 1154742872
Provider Name (Legal Business Name): BERGEN THORACIC AND VASCULAR ASSOCIATES P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/23/2013
Last Update Date: 03/03/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 ENGLE STREET - 2 EAST (FLOOR) C/O ENGLEWOOD HOSPITAL AND MEDICAL CENTER
ENGLEWOOD NJ
07631
US

IV. Provider business mailing address

5A MEDICAL PARK DRIVE ROCKLAND THORACIC & VASCULAR ASSOCIATES, P.C.
POMONA NY
10970
US

V. Phone/Fax

Practice location:
  • Phone: 201-569-1107
  • Fax: 201-569-1108
Mailing address:
  • Phone: 845-362-0075
  • Fax: 845-362-7475

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL LAWRENCE SCHWARTZ
Title or Position: SECTARY
Credential: M.D.
Phone: 845-362-0075