Healthcare Provider Details

I. General information

NPI: 1447978986
Provider Name (Legal Business Name): BERGEN PAIN & INJURY CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2022
Last Update Date: 08/19/2022
Certification Date: 08/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

214 STATE ST STE 102
HACKENSACK NJ
07601-5521
US

IV. Provider business mailing address

54 LEWIS PL
TOTOWA NJ
07512-2648
US

V. Phone/Fax

Practice location:
  • Phone: 973-512-2100
  • Fax: 973-512-2150
Mailing address:
  • Phone: 973-512-2100
  • Fax: 973-512-2150

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
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. JORGE DE LA TORRE JR.
Title or Position: OWNER
Credential: DC
Phone: 973-512-2100