Provider Demographics
NPI:1417009077
Name:BERGEN PASSAIC PEDIATRIC NEUROLOGY
Entity Type:Organization
Organization Name:BERGEN PASSAIC PEDIATRIC NEUROLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:JUDY
Authorized Official - Middle Name:
Authorized Official - Last Name:WOO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-796-9500
Mailing Address - Street 1:PO BOX 919
Mailing Address - Street 2:
Mailing Address - City:GLEN ROCK
Mailing Address - State:NJ
Mailing Address - Zip Code:07452-0919
Mailing Address - Country:US
Mailing Address - Phone:201-796-9500
Mailing Address - Fax:201-796-9509
Practice Address - Street 1:66 GLEN AVE
Practice Address - Street 2:
Practice Address - City:GLEN ROCK
Practice Address - State:NJ
Practice Address - Zip Code:07452-2132
Practice Address - Country:US
Practice Address - Phone:201-796-9500
Practice Address - Fax:201-796-9509
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-16
Last Update Date:2023-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA054944002084N0402X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0402XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology with Special Qualifications in Child NeurologyGroup - Single Specialty