Healthcare Provider Details

I. General information

NPI: 1326631490
Provider Name (Legal Business Name): BERGEN COMPASSION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/18/2021
Last Update Date: 02/18/2021
Certification Date: 02/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

230 EAST RIDGEWOOD AVENUE BUILDING 6, 2ND FLOOR
PARAMUS NJ
07652
US

IV. Provider business mailing address

71 WYANDOTTE AVE
DUMONT NJ
07628-2119
US

V. Phone/Fax

Practice location:
  • Phone: 201-225-4700
  • Fax:
Mailing address:
  • Phone: 518-368-3883
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/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: PRATHILA K NAIR
Title or Position: PSYCHIATRIST
Credential: MD
Phone: 201-225-4700