Provider Demographics
NPI:1033299763
Name:BERGEN OBSTETRICAL & GYNECOLOGICAL ASSOC PA
Entity Type:Organization
Organization Name:BERGEN OBSTETRICAL & GYNECOLOGICAL ASSOC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:IRA
Authorized Official - Middle Name:
Authorized Official - Last Name:BERNSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-489-2727
Mailing Address - Street 1:130 KINDERKAMACK RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:RIVER EDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07661-1939
Mailing Address - Country:US
Mailing Address - Phone:201-489-2727
Mailing Address - Fax:201-489-5040
Practice Address - Street 1:130 KINDERKAMACK RD
Practice Address - Street 2:SUITE 300
Practice Address - City:RIVER EDGE
Practice Address - State:NJ
Practice Address - Zip Code:07661-1939
Practice Address - Country:US
Practice Address - Phone:201-489-2727
Practice Address - Fax:201-489-5040
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-17
Last Update Date:2008-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJBE527255Medicare PIN