Provider Demographics
NPI:1093986952
Name:ION OF BERGEN LLC
Entity Type:Organization
Organization Name:ION OF BERGEN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:KUTSAK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-455-3030
Mailing Address - Street 1:71 JAMES WAY
Mailing Address - Street 2:
Mailing Address - City:EATONTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07724-2272
Mailing Address - Country:US
Mailing Address - Phone:732-455-3030
Mailing Address - Fax:800-783-5756
Practice Address - Street 1:71 JAMES WAY
Practice Address - Street 2:
Practice Address - City:EATONTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07724-2272
Practice Address - Country:US
Practice Address - Phone:732-455-3030
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-19
Last Update Date:2014-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6115440001Medicare NSC