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General NPI Number Information
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NPI Number | 1063413946
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Entity Type | Organization
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Legal Business Name | BERGEN ORTHOPEDICS, INC.
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Dates
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Enumeration Date | 08/02/2005
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 4620 NW 7TH ST
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City | MIAMI
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State | FL
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Zip | 33126-2309
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Country | US
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Telephone | 305-774-7608
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Fax | 305-774-7600
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Provider Business Mailing Address
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Address Line | 4620 NW 7TH ST
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City | MIAMI
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State | FL
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Zip | 33126-2309
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Country | US
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Telephone | 305-774-7608
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Fax | 305-774-7600
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Authorized Official
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Title or Position | PRESIDENT/ LICENSED ORTHOTIST
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Name | MS. ROSARIO VICTORIA CARRAZANA
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Credential | LO
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Telephone | 305-774-7608
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 335E00000X
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Taxonomy Name | Prosthetic/Orthotic Supplier
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License Number | ORT 87
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 335E00000X
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Taxonomy Name | Prosthetic/Orthotic Supplier
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License Number | ORT 88
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License Number State | FL
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