Healthcare Provider Details

I. General information

NPI: 1003963158
Provider Name (Legal Business Name): BERGEN SURGICAL SPECIALISTS, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/04/2007
Last Update Date: 04/16/2024
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 ESSEX ST SUITE 102
HACKENSACK NJ
07601-3231
US

IV. Provider business mailing address

211 ESSEX STREET SUITE 102
HACKENSACK NJ
07601
US

V. Phone/Fax

Practice location:
  • Phone: 201-487-8882
  • Fax: 201-487-0943
Mailing address:
  • Phone: 201-487-8882
  • Fax: 201-487-0943

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberMA59895
License Number StateNJ

VII. Legacy identifiers

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

# 1
Identifier6209009
Identifier TypeMEDICAID
Identifier StateNJ
Identifier Issuer

VIII. Authorized Official

Name: GREGORY T. SIMONIAN
Title or Position: PRESIDENT
Credential: MD
Phone: 201-446-8202