Provider Demographics
NPI:1578641924
Name:BERGEN COUNTY IMPROVEMENT AUTHORITY
Entity Type:Organization
Organization Name:BERGEN COUNTY IMPROVEMENT AUTHORITY
Other - Org Name:BERGEN NEW BRIDGE MEDICAL CENTER PSYCHIATRY PROVIDER GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR OF BCIA
Authorized Official - Prefix:
Authorized Official - First Name:MAURO
Authorized Official - Middle Name:
Authorized Official - Last Name:RAGUSEO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-336-6350
Mailing Address - Street 1:230 E RIDGEWOOD AVE BLDG 10
Mailing Address - Street 2:
Mailing Address - City:PARAMUS
Mailing Address - State:NJ
Mailing Address - Zip Code:07652-4142
Mailing Address - Country:US
Mailing Address - Phone:201-967-4001
Mailing Address - Fax:201-225-7101
Practice Address - Street 1:230 E RIDGEWOOD AVE
Practice Address - Street 2:
Practice Address - City:PARAMUS
Practice Address - State:NJ
Practice Address - Zip Code:07652-4142
Practice Address - Country:US
Practice Address - Phone:201-967-4000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-02
Last Update Date:2019-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ037311Medicare ID - Type UnspecifiedGROUP PROVIDER NO