Provider Demographics
NPI:1609928126
Name:BERGEN IMAGING CTR PA
Entity Type:Organization
Organization Name:BERGEN IMAGING CTR PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MGR
Authorized Official - Prefix:MRS
Authorized Official - First Name:TONI
Authorized Official - Middle Name:
Authorized Official - Last Name:BIALKOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:RT
Authorized Official - Phone:201-568-4242
Mailing Address - Street 1:180 NORTH DEAN ST
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07631
Mailing Address - Country:US
Mailing Address - Phone:201-568-4242
Mailing Address - Fax:201-568-1298
Practice Address - Street 1:180 NORTH DEAN ST
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07631
Practice Address - Country:US
Practice Address - Phone:201-568-4242
Practice Address - Fax:201-568-1298
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
544011Medicare ID - Type Unspecified