Healthcare Provider Details

I. General information

NPI: 1225562176
Provider Name (Legal Business Name): BERGEN NEUROLOGY & PAIN MANAGEMENT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/18/2017
Last Update Date: 12/10/2019
Certification Date: 12/10/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

480 MARKET ST STE 2
SADDLE BROOK NJ
07663-5932
US

IV. Provider business mailing address

209 BENNINGTON TER
PARAMUS NJ
07652-1335
US

V. Phone/Fax

Practice location:
  • Phone: 201-250-8088
  • Fax: 201-546-7084
Mailing address:
  • Phone: 917-536-8940
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P2900X
TaxonomyPain Medicine (Psychiatry & Neurology) Physician
License Number25MA08433600
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number25MA08433600
License Number StateNJ

VIII. Authorized Official

Name: DR. RAVINDER TIKOO
Title or Position: OWNER
Credential: MD
Phone: 917-536-8940