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General NPI Number Information
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NPI Number | 1972531523
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Entity Type | Organization
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Legal Business Name | BERGEN GASTROENTEROLOGY PC
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Dates
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Enumeration Date | 06/30/2006
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Last Update Date | 08/20/2009
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Provider Practice Location Address
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Address Line | 466 OLD HOOK RD SUITE 1
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City | EMERSON
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State | NJ
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Zip | 07630-1396
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Country | US
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Telephone | 201-967-8221
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Fax | 201-634-9647
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Provider Business Mailing Address
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Address Line | 466 OLD HOOK RD SUITE 1
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City | EMERSON
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State | NJ
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Zip | 07630-1396
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Country | US
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Telephone | 201-967-8221
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Fax |
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Authorized Official
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Title or Position | PRESIDENT/MD
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Name | DR. ERIC S AVEZZANO
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Credential | MD
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Telephone | 201-967-8221
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | 465837
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License Number State | NJ
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