Healthcare Provider Details

I. General information

NPI: 1841310315
Provider Name (Legal Business Name): ALL BERGEN PEDIATRICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/30/2007
Last Update Date: 06/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

885 MAIN ST
HACKENSACK NJ
07601-4914
US

IV. Provider business mailing address

885 MAIN ST
HACKENSACK NJ
07601-4914
US

V. Phone/Fax

Practice location:
  • Phone: 201-487-0947
  • Fax: 201-487-3009
Mailing address:
  • Phone: 201-487-0947
  • Fax: 201-487-3009

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
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. JOSEPH S FRUCHTER
Title or Position: PHYSICIAN
Credential: MD
Phone: 201-487-0947