Provider Demographics
NPI:1740202845
Name:ENDOSCOPY CENTER OF BERGEN COUNTY, LLC
Entity Type:Organization
Organization Name:ENDOSCOPY CENTER OF BERGEN COUNTY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:AVEZZANO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-967-8221
Mailing Address - Street 1:80 EISENHOWER DR
Mailing Address - Street 2:
Mailing Address - City:PARAMUS
Mailing Address - State:NJ
Mailing Address - Zip Code:07652-1401
Mailing Address - Country:US
Mailing Address - Phone:201-336-1100
Mailing Address - Fax:201-336-1040
Practice Address - Street 1:80 EISENHOWER DR
Practice Address - Street 2:
Practice Address - City:PARAMUS
Practice Address - State:NJ
Practice Address - Zip Code:07652-1401
Practice Address - Country:US
Practice Address - Phone:201-336-1100
Practice Address - Fax:201-336-1040
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical