Provider Demographics
NPI:1205060589
Name:BERGEN PEDIATRIC THERAPY CENTER
Entity type:Organization
Organization Name:BERGEN PEDIATRIC THERAPY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:VICTOR
Authorized Official - Middle Name:
Authorized Official - Last Name:WANG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-722-4700
Mailing Address - Street 1:354 OLD HOOK RD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:WESTWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07675-3246
Mailing Address - Country:US
Mailing Address - Phone:201-722-4700
Mailing Address - Fax:201-722-4751
Practice Address - Street 1:354 OLD HOOK RD
Practice Address - Street 2:SUITE 104
Practice Address - City:WESTWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07675-3246
Practice Address - Country:US
Practice Address - Phone:201-722-4700
Practice Address - Fax:201-722-4751
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-14
Last Update Date:2009-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TA09005200224Z00000X
NJ46TR00016700225XP0200X
NJ46TR00035200225XP0200X
NJ46TR00480300225XP0200X
NJ46TR00474300225XP0200X
NJ41YS00541700235Z00000X
NJ46TR00322900225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Multi-Specialty
No224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy AssistantGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty