Provider Demographics
NPI:1235317298
Name:COUNTY OF BERGEN
Entity Type:Organization
Organization Name:COUNTY OF BERGEN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADVANCE PRACTICE NURSE
Authorized Official - Prefix:
Authorized Official - First Name:DEIDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:PARKS
Authorized Official - Suffix:
Authorized Official - Credentials:RN MSN CPNP, APN
Authorized Official - Phone:201-336-3912
Mailing Address - Street 1:200 NORTH ST
Mailing Address - Street 2:
Mailing Address - City:TETERBORO
Mailing Address - State:NJ
Mailing Address - Zip Code:07608-1214
Mailing Address - Country:US
Mailing Address - Phone:201-336-3912
Mailing Address - Fax:
Practice Address - Street 1:200 NORTH ST
Practice Address - Street 2:
Practice Address - City:TETERBORO
Practice Address - State:NJ
Practice Address - Zip Code:07608-1214
Practice Address - Country:US
Practice Address - Phone:201-336-3912
Practice Address - Fax:201-336-3919
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-01
Last Update Date:2015-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare