Healthcare Provider Details

I. General information

NPI: 1194816249
Provider Name (Legal Business Name): BERGEN ANESTHESIA GROUP, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/27/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

223 N VAN DIEN AVE OPERATING ROOM
RIDGEWOOD NJ
07450-2726
US

IV. Provider business mailing address

500 W MAIN ST SUITE 16
WYCKOFF NJ
07481-1439
US

V. Phone/Fax

Practice location:
  • Phone: 201-847-9403
  • Fax:
Mailing address:
  • Phone: 201-847-9320
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: DR. MICHAEL SCOGNAMIGLIO
Title or Position: PRESIDENT
Credential: MD
Phone: 201-847-9320