Healthcare Provider Details

I. General information

NPI: 1497439228
Provider Name (Legal Business Name): BERGENLINE OPTOMETRY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/12/2023
Last Update Date: 06/12/2023
Certification Date: 06/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5618 BERGENLINE AVE
WEST NEW YORK NJ
07093-1232
US

IV. Provider business mailing address

5618 BERGENLINE AVE
WEST NEW YORK NJ
07093-1232
US

V. Phone/Fax

Practice location:
  • Phone: 201-867-2942
  • Fax:
Mailing address:
  • Phone: 201-867-2942
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: POOJA KADAKIA
Title or Position: OD
Credential:
Phone: 732-861-4306