Healthcare Provider Details

I. General information

NPI: 1730329475
Provider Name (Legal Business Name): B&B MEDICAL SPECIALTIES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/20/2009
Last Update Date: 08/14/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

639 TEANECK RD
TEANECK NJ
07666-4258
US

IV. Provider business mailing address

219 LAFAYETTE AVE
HAWTHORNE NJ
07506-1904
US

V. Phone/Fax

Practice location:
  • Phone: 973-423-9100
  • Fax: 973-423-1339
Mailing address:
  • Phone: 973-423-9100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMA083427
License Number StateNJ

VIII. Authorized Official

Name: DR. ROBERT BERBERIAN
Title or Position: PRESIDENT
Credential: MD
Phone: 201-446-3924