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General NPI Number Information
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NPI Number | 1679770952
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Entity Type | Organization
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Legal Business Name | BERGEN KIDNEY CENTER PC
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Dates
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Enumeration Date | 06/29/2007
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Last Update Date | 02/04/2026
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Provider Practice Location Address
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Address Line | 300 GRAND AVENUE SUITE 101
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City | ENGLEWOOD
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State | NJ
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Zip | 07631-6581
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Country | US
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Telephone | 201-567-5787
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Fax | 201-567-7652
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Provider Business Mailing Address
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Address Line | 300 GRAND AVE STE 101
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City | ENGLEWOOD
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State | NJ
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Zip | 07631-6300
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Country | US
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Telephone | 201-567-5787
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Fax | 201-567-7652
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Authorized Official
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Title or Position | CREDENTIALING MANAGER
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Name | NAOMI CASSIN
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Credential |
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Telephone | 331-216-1156
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RN0300X
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Taxonomy Name | Nephrology Physician
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License Number | MA057981
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License Number State | NJ
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