Provider Demographics
NPI:1720507155
Name:SIDDHIPRIYA INC
Entity Type:Organization
Organization Name:SIDDHIPRIYA INC
Other - Org Name:BERGEN PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DEVANG
Authorized Official - Middle Name:
Authorized Official - Last Name:NAGRECHA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-632-4994
Mailing Address - Street 1:23 CANOE BROOK DR
Mailing Address - Street 2:
Mailing Address - City:LIVINGSTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07039-6121
Mailing Address - Country:US
Mailing Address - Phone:973-632-4994
Mailing Address - Fax:
Practice Address - Street 1:240 WILLIAMSON ST STE 101
Practice Address - Street 2:
Practice Address - City:ELIZABETH
Practice Address - State:NJ
Practice Address - Zip Code:07202-3671
Practice Address - Country:US
Practice Address - Phone:908-994-9700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SIDDHIPRIYA INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-09-18
Last Update Date:2017-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RS00728000332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0392065Medicaid