Provider Demographics
NPI:1235959099
Name:SOUTH BERGEN MEDICAL ASSOCIATES PA
Entity type:Organization
Organization Name:SOUTH BERGEN MEDICAL ASSOCIATES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:MARINI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-291-8800
Mailing Address - Street 1:PO BOX 354
Mailing Address - Street 2:
Mailing Address - City:ROCHELLE PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07662-0354
Mailing Address - Country:US
Mailing Address - Phone:201-291-1619
Mailing Address - Fax:201-291-0637
Practice Address - Street 1:251 ROCHELLE AVE STE C
Practice Address - Street 2:
Practice Address - City:ROCHELLE PARK
Practice Address - State:NJ
Practice Address - Zip Code:07662-3914
Practice Address - Country:US
Practice Address - Phone:201-291-8800
Practice Address - Fax:201-291-0637
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-15
Last Update Date:2024-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207RA0000XAllopathic & Osteopathic PhysiciansInternal MedicineAdolescent MedicineGroup - Multi-Specialty
No2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic UltrasoundGroup - Multi-Specialty