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General NPI Number Information
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NPI Number | 1013075654
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Entity Type | Organization
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Legal Business Name | BERGEN P.T. ASSOCIATES, LLC
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Dates
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Enumeration Date | 12/05/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 495 BOULEVARD UNIT 4
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City | ELMWOOD PARK
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State | NJ
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Zip | 07407-2041
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Country | US
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Telephone | 201-370-7195
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Fax |
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Provider Business Mailing Address
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Address Line | 495 BOULEVARD UNIT 4
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City | ELMWOOD PARK
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State | NJ
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Zip | 07407-2041
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Country | US
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Telephone | 201-370-7195
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. HOWARD JAMES PHILLIPS
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Credential | PT, PHD OCS, FAAOMPT
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Telephone | 201-370-7195
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | 40QA00296600
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License Number State | NJ
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