Provider Demographics
NPI:1073727483
Name:BERGEN HEART CENTER, PC
Entity Type:Organization
Organization Name:BERGEN HEART CENTER, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DELEGATED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:PERMINDER
Authorized Official - Middle Name:
Authorized Official - Last Name:GREWAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-444-9913
Mailing Address - Street 1:85 CHESTNUT RIDGE RD
Mailing Address - Street 2:SUITE 11
Mailing Address - City:MONTVALE
Mailing Address - State:NJ
Mailing Address - Zip Code:07645-1827
Mailing Address - Country:US
Mailing Address - Phone:201-444-9913
Mailing Address - Fax:201-844-6158
Practice Address - Street 1:85 CHESTNUT RIDGE RD
Practice Address - Street 2:SUITE 11
Practice Address - City:MONTVALE
Practice Address - State:NJ
Practice Address - Zip Code:07645-1827
Practice Address - Country:US
Practice Address - Phone:201-444-9913
Practice Address - Fax:201-844-6158
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-09
Last Update Date:2010-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA04252600174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7794956OtherAETNA PPO GROUP#
NJ1599845OtherAETNA HMO GROUP#
NJ2864697000OtherAMERIHEALTH GROUP#
NJ7794956OtherAETNA PPO GROUP#