Provider Demographics
NPI:1326182346
Name:BERGEN FAMILY FOOT CARE, LLC
Entity Type:Organization
Organization Name:BERGEN FAMILY FOOT CARE, LLC
Other - Org Name:BERGEN FAMILY FOOT CARE, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:CAPONIGRO
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:201-794-3223
Mailing Address - Street 1:67 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:ELMWOOD PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07407
Mailing Address - Country:US
Mailing Address - Phone:201-794-3223
Mailing Address - Fax:201-794-8411
Practice Address - Street 1:67 BROADWAY
Practice Address - Street 2:
Practice Address - City:ELMWOOD PARK
Practice Address - State:NJ
Practice Address - Zip Code:07407-1836
Practice Address - Country:US
Practice Address - Phone:201-794-3223
Practice Address - Fax:201-794-8411
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-16
Last Update Date:2008-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMD02533213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJU72947Medicare UPIN
NJ4599100001Medicare NSC
NJ035759Medicare ID - Type Unspecified