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General NPI Number Information
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NPI Number | 1225562176
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Entity Type | Organization
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Legal Business Name | BERGEN NEUROLOGY & PAIN MANAGEMENT LLC
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Dates
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Enumeration Date | 04/18/2017
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Last Update Date | 12/10/2019
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Provider Practice Location Address
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Address Line | 480 MARKET ST STE 2
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City | SADDLE BROOK
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State | NJ
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Zip | 07663-5932
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Country | US
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Telephone | 201-250-8088
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Fax | 201-546-7084
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Provider Business Mailing Address
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Address Line | 209 BENNINGTON TER
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City | PARAMUS
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State | NJ
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Zip | 07652-1335
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Country | US
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Telephone | 917-536-8940
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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. RAVINDER TIKOO
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Credential | MD
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Telephone | 917-536-8940
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P2900X
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Taxonomy Name | Pain Medicine (Psychiatry & Neurology) Physician
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License Number | 25MA08433600
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | 25MA08433600
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License Number State | NJ
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