Provider Demographics
NPI:1972757755
Name:BERGEN VOLUNTEER MEDICAL INITIATIVE
Entity Type:Organization
Organization Name:BERGEN VOLUNTEER MEDICAL INITIATIVE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ARTHUR
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:DE SIMONE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-342-2478
Mailing Address - Street 1:75 ESSEX ST STE 100
Mailing Address - Street 2:
Mailing Address - City:HACKENSACK
Mailing Address - State:NJ
Mailing Address - Zip Code:07601-4034
Mailing Address - Country:US
Mailing Address - Phone:202-342-2478
Mailing Address - Fax:201-518-8494
Practice Address - Street 1:75 ESSEX ST STE 100
Practice Address - Street 2:
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601-4034
Practice Address - Country:US
Practice Address - Phone:201-342-2478
Practice Address - Fax:201-518-8494
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-06
Last Update Date:2023-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center