Healthcare Provider Details

I. General information

NPI: 1346730645
Provider Name (Legal Business Name): SPORTS MEDICINE CENTER OF BERGEN, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/14/2018
Last Update Date: 05/14/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33 UNION PL
SUMMIT NJ
07901-3650
US

IV. Provider business mailing address

605 MAIN ST
HACKENSACK NJ
07601-5914
US

V. Phone/Fax

Practice location:
  • Phone: 908-738-1661
  • Fax:
Mailing address:
  • Phone: 201-488-0488
  • Fax: 201-343-5325

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: KIMBERLY HUNTER
Title or Position: ADMIN MGR
Credential:
Phone: 201-488-0488