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General NPI Number Information
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NPI Number | 1073995304
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Entity Type | Organization
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Legal Business Name | SPORTS MEDICINE CENTER OF BERGEN, PA
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Dates
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Enumeration Date | 06/23/2015
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Last Update Date | 05/24/2016
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Provider Practice Location Address
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Address Line | 1019 MACARTHUR BLVD EXCEL ORTHOPEDIC REHABILITATION
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City | MAHWAH
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State | NJ
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Zip | 07430
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Country | US
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Telephone | 201-818-8711
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Fax | 201-818-8744
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Provider Business Mailing Address
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Address Line | 605 MAIN STREET EXCEL ORTHOPEDIC REHABILITATION
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City | HACKENSACK
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State | NJ
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Zip | 07601
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Country | US
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Telephone | 201-488-0488
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Fax |
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | MR. GARY FLINK
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Credential | P.T.
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Telephone | 201-488-0488
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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