Healthcare Provider Details

I. General information

NPI: 1346300753
Provider Name (Legal Business Name): HUGH BERGKNOFF MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/08/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4575 RTE 27
KINGSTON NJ
08528
US

IV. Provider business mailing address

102 N THIRD AVENUE
HIGHLAND PARK NJ
08904
US

V. Phone/Fax

Practice location:
  • Phone: 609-683-7979
  • Fax: 609-683-1972
Mailing address:
  • Phone: 732-846-0366
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberMA42496
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: