Healthcare Provider Details

I. General information

NPI: 1699048322
Provider Name (Legal Business Name): BERGENLINE SPINE AND HEALTHCARE CENTER PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/10/2012
Last Update Date: 05/24/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6000 KENNEDY BLVD W
WEST NEW YORK NJ
07093-1414
US

IV. Provider business mailing address

PO BOX 5262
WEST NEW YORK NJ
07093-9262
US

V. Phone/Fax

Practice location:
  • Phone: 201-758-0099
  • Fax: 201-758-2992
Mailing address:
  • Phone: 201-758-0099
  • Fax: 201-758-2992

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number25MZ00059400
License Number StateNJ
# 7
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number40QA00729000
License Number StateNJ
# 8
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: PETER WOHL
Title or Position: MANAGER
Credential: D.C.
Phone: 201-758-0099