1063413946 NPI number — BERGEN ORTHOPEDICS, INC.

Table of content: (NPI 1063413946)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063413946 NPI number — BERGEN ORTHOPEDICS, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BERGEN ORTHOPEDICS, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1063413946
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4620 NW 7TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MIAMI
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33126-2309
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
305-774-7608
Provider Business Mailing Address Fax Number:
305-774-7600

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4620 NW 7TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MIAMI
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33126-2309
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
305-774-7608
Provider Business Practice Location Address Fax Number:
305-774-7600
Provider Enumeration Date:
08/02/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
CARRAZANA
Authorized Official First Name:
ROSARIO
Authorized Official Middle Name:
VICTORIA
Authorized Official Title or Position:
PRESIDENT/ LICENSED ORTHOTIST
Authorized Official Telephone Number:
305-774-7608

Provider Taxonomy Codes

  • Taxonomy code: 335E00000X , with the licence number:  ORT 88 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 335E00000X , with the licence number: ORT 87 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)