1609890136 NPI number — BERGEN INST OF INTNL MEDICINE PA

Table of content: (NPI 1609890136)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609890136 NPI number — BERGEN INST OF INTNL MEDICINE PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BERGEN INST OF INTNL MEDICINE PA
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:
6
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:
1609890136
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/20/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
316 KNICKERBOCKER RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DUMONT
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07628
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
201-385-6161
Provider Business Mailing Address Fax Number:
201-501-8365

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
316 KNICKERBOCKER RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DUMONT
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07628
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
201-385-6161
Provider Business Practice Location Address Fax Number:
201-501-8365
Provider Enumeration Date:
07/27/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BASKIN
Authorized Official First Name:
ALAN
Authorized Official Middle Name:
ROY
Authorized Official Title or Position:
PARTNER
Authorized Official Telephone Number:
201-385-6111

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207RC0000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: CL7785 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".




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