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General NPI Number Information
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NPI Number | 1205060589
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Entity Type | Organization
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Legal Business Name | BERGEN PEDIATRIC THERAPY CENTER
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Dates
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Enumeration Date | 05/14/2009
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Last Update Date | 05/14/2009
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Provider Practice Location Address
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Address Line | 354 OLD HOOK RD SUITE 104
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City | WESTWOOD
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State | NJ
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Zip | 07675-3246
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Country | US
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Telephone | 201-722-4700
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Fax | 201-722-4751
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Provider Business Mailing Address
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Address Line | 354 OLD HOOK RD SUITE 104
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City | WESTWOOD
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State | NJ
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Zip | 07675-3246
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Country | US
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Telephone | 201-722-4700
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Fax | 201-722-4751
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Authorized Official
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Title or Position | DIRECTOR
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Name | MR. VICTOR WANG
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Credential |
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Telephone | 201-722-4700
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 224Z00000X
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Taxonomy Name | Occupational Therapy Assistant
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License Number | 46TA09005200
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 225XP0200X
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Taxonomy Name | Pediatric Occupational Therapist
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License Number | 46TR00016700
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License Number State | NJ
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Taxonomy #3
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Taxonomy Code | 225XP0200X
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Taxonomy Name | Pediatric Occupational Therapist
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License Number | 46TR00035200
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License Number State | NJ
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Taxonomy #4
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Taxonomy Code | 225XP0200X
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Taxonomy Name | Pediatric Occupational Therapist
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License Number | 46TR00480300
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License Number State | NJ
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Taxonomy #5
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Taxonomy Code | 225XP0200X
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Taxonomy Name | Pediatric Occupational Therapist
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License Number | 46TR00474300
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License Number State | NJ
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Taxonomy #6
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 41YS00541700
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License Number State | NJ
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Taxonomy #7
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Taxonomy Code | 225XP0200X
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Taxonomy Name | Pediatric Occupational Therapist
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License Number | 46TR00322900
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License Number State | NJ
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