Provider Demographics
NPI:1275646663
Name:BERGEN EAR, NOSE AND THROAT ASSOC. PA
Entity Type:Organization
Organization Name:BERGEN EAR, NOSE AND THROAT ASSOC. PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:B
Authorized Official - Last Name:LOW
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-489-6520
Mailing Address - Street 1:20 PROSPECT AVE
Mailing Address - Street 2:SUITE 909
Mailing Address - City:HACKENSACK
Mailing Address - State:NJ
Mailing Address - Zip Code:07601-1997
Mailing Address - Country:US
Mailing Address - Phone:201-489-6520
Mailing Address - Fax:201-489-6530
Practice Address - Street 1:20 PROSPECT AVE
Practice Address - Street 2:SUITE 909
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601-1997
Practice Address - Country:US
Practice Address - Phone:201-489-6520
Practice Address - Fax:201-489-6530
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJH41377Medicare UPIN
NJD92518Medicare UPIN
NJ459727Medicare ID - Type UnspecifiedDR LOW & DR INOUYE GROUP