Provider Demographics
NPI:1639609944
Name:BERGEN DOULA, LLC
Entity Type:Organization
Organization Name:BERGEN DOULA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BIRTH DOULA & LACTATION COUNSELOR
Authorized Official - Prefix:MS
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:SAUER
Authorized Official - Last Name:PASTERNAK
Authorized Official - Suffix:
Authorized Official - Credentials:CLC
Authorized Official - Phone:201-245-7614
Mailing Address - Street 1:71 BERKELEY DR
Mailing Address - Street 2:
Mailing Address - City:TENAFLY
Mailing Address - State:NJ
Mailing Address - Zip Code:07670-1224
Mailing Address - Country:US
Mailing Address - Phone:201-245-7614
Mailing Address - Fax:201-567-0258
Practice Address - Street 1:332 E RTE 4 LBBY 2ND
Practice Address - Street 2:
Practice Address - City:PARAMUS
Practice Address - State:NJ
Practice Address - Zip Code:07652-5114
Practice Address - Country:US
Practice Address - Phone:201-245-7614
Practice Address - Fax:201-567-0258
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-19
Last Update Date:2017-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374J00000XNursing Service Related ProvidersDoulaGroup - Multi-Specialty
No174N00000XOther Service ProvidersLactation Consultant, Non-RNGroup - Multi-Specialty