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General NPI Number Information
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NPI Number | 1144730987
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Entity Type | Organization
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Legal Business Name | BERGEN BARIATRIC AND SURGICAL SOLUTIONS PC
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Dates
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Enumeration Date | 10/06/2017
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Last Update Date | 06/17/2020
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Provider Practice Location Address
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Address Line | 260 OLD HOOK ROAD, SUITE 303A
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City | WESTWOOD
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State | NJ
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Zip | 07675-3123
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Country | US
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Telephone | 201-778-5344
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Fax | 201-778-5399
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Provider Business Mailing Address
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Address Line | 23 ROBYN CT
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City | EMERSON
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State | NJ
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Zip | 07630-1464
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Country | US
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Telephone | 201-778-5344
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Fax | 201-778-5399
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Authorized Official
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Title or Position | OWNER
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Name | DR. MIKHAIL A. BOTVINOV
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Credential | D.O.
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Telephone | 201-693-2653
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number |
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License Number State | NJ
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