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General NPI Number Information
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NPI Number | 1962722595
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Entity Type | Organization
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Legal Business Name | BERGEN MEDICAL SPORTS & SPINE, INC.
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Dates
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Enumeration Date | 06/05/2010
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Last Update Date | 06/05/2010
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Provider Practice Location Address
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Address Line | 1 SEARS DR THIRD FLOOR
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City | PARAMUS
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State | NJ
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Zip | 07652-3515
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Country | US
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Telephone | 201-261-5220
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Fax | 201-261-5223
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Provider Business Mailing Address
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Address Line | 131 CRAIG RD
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City | HILLSDALE
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State | NJ
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Zip | 07642-1054
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Country | US
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Telephone | 201-888-0021
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Fax | 201-722-3560
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. GARY STEVEN HERRING
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Credential | M.D.
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Telephone | 201-888-0021
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QS0010X
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Taxonomy Name | Sports Medicine (Family Medicine) Physician
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License Number | MA55527
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License Number State | NJ
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