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General NPI Number Information
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NPI Number | 1265655310
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Entity Type | Organization
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Legal Business Name | BERGEN ORTHODONTIC ASSOC., PA
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Dates
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Enumeration Date | 04/10/2007
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Last Update Date | 02/27/2008
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Provider Practice Location Address
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Address Line | 500 PIERMONT RD
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City | CLOSTER
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State | NJ
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Zip | 07624-2845
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Country | US
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Telephone | 201-768-4121
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Fax | 201-768-3495
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Provider Business Mailing Address
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Address Line | 500 PIERMONT RD
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City | CLOSTER
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State | NJ
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Zip | 07624-2845
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Country | US
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Telephone | 201-768-4121
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Fax | 201-768-3495
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MARTIN STANLEY LEVITT
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Credential | D.D.S.
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Telephone | 201-768-4121
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 8033, 2174
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License Number State | NJ
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