Healthcare Provider Details

I. General information

NPI: 1740202845
Provider Name (Legal Business Name): ENDOSCOPY CENTER OF BERGEN COUNTY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/25/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 EISENHOWER DR
PARAMUS NJ
07652-1401
US

IV. Provider business mailing address

80 EISENHOWER DR
PARAMUS NJ
07652-1401
US

V. Phone/Fax

Practice location:
  • Phone: 201-336-1100
  • Fax: 201-336-1040
Mailing address:
  • Phone: 201-336-1100
  • Fax: 201-336-1040

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. ERIC AVEZZANO
Title or Position: PRESIDENT
Credential: MD
Phone: 201-967-8221