Healthcare Provider Details

I. General information

NPI: 1033299763
Provider Name (Legal Business Name): BERGEN OBSTETRICAL & GYNECOLOGICAL ASSOC PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2006
Last Update Date: 01/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 KINDERKAMACK RD SUITE 300
RIVER EDGE NJ
07661-1939
US

IV. Provider business mailing address

130 KINDERKAMACK RD SUITE 300
RIVER EDGE NJ
07661-1939
US

V. Phone/Fax

Practice location:
  • Phone: 201-489-2727
  • Fax: 201-489-5040
Mailing address:
  • Phone: 201-489-2727
  • Fax: 201-489-5040

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. IRA BERNSTEIN
Title or Position: PRESIDENT
Credential: M.D.
Phone: 201-489-2727