Provider Demographics
NPI:1851313720
Name:BERGEN NEUROPSYCHOLOGY GROUP
Entity Type:Organization
Organization Name:BERGEN NEUROPSYCHOLOGY GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETER
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:CRAIG
Authorized Official - Last Name:KUTNER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:201-894-0050
Mailing Address - Street 1:440 CURRY AVE STE B
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07631-1794
Mailing Address - Country:US
Mailing Address - Phone:201-894-0050
Mailing Address - Fax:
Practice Address - Street 1:440 CURRY AVE STE B
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07631-1794
Practice Address - Country:US
Practice Address - Phone:201-894-0050
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ2135103G00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Multi-Specialty
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty