Healthcare Provider Details

I. General information

NPI: 1184537672
Provider Name (Legal Business Name): BERGEN ALL-STARS A NJ NON PROFIT CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/24/2026
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 STEVENSON LN
UPPER SADDLE RIVER NJ
07458-2228
US

IV. Provider business mailing address

40 STEVENSON LN
UPPER SADDLE RIVER NJ
07458-2228
US

V. Phone/Fax

Practice location:
  • Phone: 201-233-3685
  • Fax:
Mailing address:
  • Phone: 201-233-3685
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name: SUNCHOO JUDY SHIN
Title or Position: COORDINATOR
Credential: MA
Phone: 201-233-3685