Healthcare Provider Details

I. General information

NPI: 1336185131
Provider Name (Legal Business Name): BERGEN LAPAROSCOPIC AND GENERAL SURGERY PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/21/2006
Last Update Date: 12/05/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

449 B MARKET ST
SADDLE BROOK NJ
07663
US

IV. Provider business mailing address

449 B MARKET ST
SADDLE BROOK NJ
07663
US

V. Phone/Fax

Practice location:
  • Phone: 201-712-7900
  • Fax: 201-712-7902
Mailing address:
  • Phone: 201-712-7900
  • Fax: 201-712-7902

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberMB52216
License Number State

VIII. Authorized Official

Name: DR. JOHN C KOLLAR
Title or Position: SURGEON
Credential: DO
Phone: 201-712-7900