Provider Demographics
NPI:1598860280
Name:BERGEN DERMATOLOGY SPECIALISTS PA
Entity Type:Organization
Organization Name:BERGEN DERMATOLOGY SPECIALISTS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KARIN
Authorized Official - Middle Name:H
Authorized Official - Last Name:SATRA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:415-802-1310
Mailing Address - Street 1:400 ROUTE 17 SOUTH
Mailing Address - Street 2:
Mailing Address - City:RIDGEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07450
Mailing Address - Country:US
Mailing Address - Phone:415-802-1310
Mailing Address - Fax:201-652-4906
Practice Address - Street 1:400 ROUTE 17 SOUTH
Practice Address - Street 2:
Practice Address - City:RIDGEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07450
Practice Address - Country:US
Practice Address - Phone:415-802-1310
Practice Address - Fax:201-652-4906
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-14
Last Update Date:2021-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2619903Medicaid
NJ2619903Medicaid