Provider Demographics
NPI:1073995304
Name:SPORTS MEDICINE CENTER OF BERGEN, PA
Entity Type:Organization
Organization Name:SPORTS MEDICINE CENTER OF BERGEN, PA
Other - Org Name:EXCEL ORTHOPEDIC REHABILITATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:
Authorized Official - Last Name:FLINK
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:201-488-0488
Mailing Address - Street 1:605 MAIN STREET
Mailing Address - Street 2:EXCEL ORTHOPEDIC REHABILITATION
Mailing Address - City:HACKENSACK
Mailing Address - State:NJ
Mailing Address - Zip Code:07601
Mailing Address - Country:US
Mailing Address - Phone:201-488-0488
Mailing Address - Fax:
Practice Address - Street 1:1019 MACARTHUR BLVD
Practice Address - Street 2:EXCEL ORTHOPEDIC REHABILITATION
Practice Address - City:MAHWAH
Practice Address - State:NJ
Practice Address - Zip Code:07430
Practice Address - Country:US
Practice Address - Phone:201-818-8711
Practice Address - Fax:201-818-8744
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SPORTS PHYSICAL THERAPY CENTER OF BERGEN, PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-06-23
Last Update Date:2016-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ044081Medicare UPIN