Provider Demographics
NPI:1548567365
Name:BERGEN DERMATOLOGY LLC
Entity Type:Organization
Organization Name:BERGEN DERMATOLOGY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ACHIAMAH
Authorized Official - Middle Name:
Authorized Official - Last Name:OSEI-TUTU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-984-3969
Mailing Address - Street 1:13 PIERSON CT
Mailing Address - Street 2:
Mailing Address - City:MAHWAH
Mailing Address - State:NJ
Mailing Address - Zip Code:07430-3506
Mailing Address - Country:US
Mailing Address - Phone:201-567-7546
Mailing Address - Fax:
Practice Address - Street 1:600 E PALISADE AVE
Practice Address - Street 2:SUITE 5
Practice Address - City:ENGLEWOOD CLIFFS
Practice Address - State:NJ
Practice Address - Zip Code:07632-1828
Practice Address - Country:US
Practice Address - Phone:201-567-1087
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-14
Last Update Date:2011-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY251302207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty