=====================================================
General NPI Number Information
=====================================================
NPI Number | 1316814916
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BERGEN JHP PT PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/20/2025
-----------------------------------------------------
Last Update Date | 10/20/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 333 SYLVAN AVE STE 326
-----------------------------------------------------
City | ENGLEWOOD CLIFFS
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07632-2734
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 201-408-5016
-----------------------------------------------------
Fax | 201-877-1062
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 333 SYLVAN AVE STE 326
-----------------------------------------------------
City | ENGLEWOOD CLIFFS
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07632-2734
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 201-408-5016
-----------------------------------------------------
Fax | 201-877-1062
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHYSICAL THERAPIST/OWNER
-----------------------------------------------------
Name | JAEHYUN PARK
-----------------------------------------------------
Credential | DPT
-----------------------------------------------------
Telephone | 201-408-5016
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------