Provider Demographics
NPI:1447468475
Name:BERGEN MEDICAL CENTER MULTI SPECIALTY GROUP, LLC
Entity type:Organization
Organization Name:BERGEN MEDICAL CENTER MULTI SPECIALTY GROUP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMIN
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:SHANTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-262-8274
Mailing Address - Street 1:1 W RIDGEWOOD AVE
Mailing Address - Street 2:G3
Mailing Address - City:PARAMUS
Mailing Address - State:NJ
Mailing Address - Zip Code:07652-2359
Mailing Address - Country:US
Mailing Address - Phone:201-262-8274
Mailing Address - Fax:201-262-8718
Practice Address - Street 1:1 W RIDGEWOOD AVE
Practice Address - Street 2:G3
Practice Address - City:PARAMUS
Practice Address - State:NJ
Practice Address - Zip Code:07652-2359
Practice Address - Country:US
Practice Address - Phone:201-262-8274
Practice Address - Fax:201-262-8718
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA490092083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational MedicineGroup - Multi-Specialty