Healthcare Provider Details

I. General information

NPI: 1962722595
Provider Name (Legal Business Name): BERGEN MEDICAL SPORTS & SPINE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/05/2010
Last Update Date: 06/05/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 SEARS DR THIRD FLOOR
PARAMUS NJ
07652-3515
US

IV. Provider business mailing address

131 CRAIG RD
HILLSDALE NJ
07642-1054
US

V. Phone/Fax

Practice location:
  • Phone: 201-261-5220
  • Fax: 201-261-5223
Mailing address:
  • Phone: 201-888-0021
  • Fax: 201-722-3560

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License NumberMA55527
License Number StateNJ

VIII. Authorized Official

Name: DR. GARY STEVEN HERRING
Title or Position: PRESIDENT
Credential: M.D.
Phone: 201-888-0021