Provider Demographics
NPI:1003963158
Name:BERGEN SURGICAL SPECIALISTS, PA
Entity Type:Organization
Organization Name:BERGEN SURGICAL SPECIALISTS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:T
Authorized Official - Last Name:SIMONIAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-446-8202
Mailing Address - Street 1:211 ESSEX STREET
Mailing Address - Street 2:SUITE 102
Mailing Address - City:HACKENSACK
Mailing Address - State:NJ
Mailing Address - Zip Code:07601
Mailing Address - Country:US
Mailing Address - Phone:201-487-8882
Mailing Address - Fax:201-487-0943
Practice Address - Street 1:211 ESSEX ST
Practice Address - Street 2:SUITE 102
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601-3231
Practice Address - Country:US
Practice Address - Phone:201-487-8882
Practice Address - Fax:201-487-0943
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-04
Last Update Date:2024-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA59895174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6209009Medicaid
NJ6209009Medicaid
NJ161877Medicare ID - Type Unspecified