Healthcare Provider Details

I. General information

NPI: 1417132564
Provider Name (Legal Business Name): BERGEN DENTAL PROFESSIONAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/08/2008
Last Update Date: 01/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

379 UNION ST
HACKENSACK NJ
07601-4326
US

IV. Provider business mailing address

379 UNION ST
HACKENSACK NJ
07601-4326
US

V. Phone/Fax

Practice location:
  • Phone: 201-488-4777
  • Fax: 201-457-0848
Mailing address:
  • Phone: 201-488-4777
  • Fax: 201-457-0848

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DR. PAUL W. ALBERG
Title or Position: OWNER
Credential: D.M.D., P.C.
Phone: 201-488-4777