Healthcare Provider Details

I. General information

NPI: 1528390499
Provider Name (Legal Business Name): BERGEN SURGICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/03/2010
Last Update Date: 02/03/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 W RIDGEWOOD AVE
PARAMUS NJ
07652-2359
US

IV. Provider business mailing address

1 W RIDGEWOOD AVE
PARAMUS NJ
07652-2359
US

V. Phone/Fax

Practice location:
  • Phone: 201-262-8271
  • Fax:
Mailing address:
  • Phone: 201-262-8271
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number StateNJ

VIII. Authorized Official

Name: DR. JEFFREY S LIVA
Title or Position: OWNER
Credential: M.D.
Phone: 201-262-8271