Provider Demographics
NPI:1801091475
Name:MID BERGEN REGIONAL HEALTH COMMISSION
Entity type:Organization
Organization Name:MID BERGEN REGIONAL HEALTH COMMISSION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HEALTH OFFICER DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SAM
Authorized Official - Middle Name:
Authorized Official - Last Name:YANOVICH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-599-6290
Mailing Address - Street 1:930 RIVER RD
Mailing Address - Street 2:
Mailing Address - City:NEW MILFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:07646-3043
Mailing Address - Country:US
Mailing Address - Phone:201-599-6290
Mailing Address - Fax:201-262-7783
Practice Address - Street 1:930 RIVER RD
Practice Address - Street 2:
Practice Address - City:NEW MILFORD
Practice Address - State:NJ
Practice Address - Zip Code:07646-3043
Practice Address - Country:US
Practice Address - Phone:201-599-6290
Practice Address - Fax:201-262-7783
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-15
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
171956Medicare ID - Type Unspecified