Provider Demographics
NPI:1881805711
Name:BERGEN MEDICAL IMAGING, LLC
Entity type:Organization
Organization Name:BERGEN MEDICAL IMAGING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LYNNE
Authorized Official - Middle Name:
Authorized Official - Last Name:KOHLMANN
Authorized Official - Suffix:
Authorized Official - Credentials:RN, AMT
Authorized Official - Phone:201-646-0520
Mailing Address - Street 1:2 SEARS DR
Mailing Address - Street 2:
Mailing Address - City:PARAMUS
Mailing Address - State:NJ
Mailing Address - Zip Code:07652-3539
Mailing Address - Country:US
Mailing Address - Phone:201-652-0188
Mailing Address - Fax:201-646-9531
Practice Address - Street 1:2 SEARS DR
Practice Address - Street 2:
Practice Address - City:PARAMUS
Practice Address - State:NJ
Practice Address - Zip Code:07652-3539
Practice Address - Country:US
Practice Address - Phone:201-652-0188
Practice Address - Fax:201-646-9531
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-24
Last Update Date:2010-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ=========OtherEIN NUMBER