Provider Demographics
NPI:1063413946
Name:BERGEN ORTHOPEDICS, INC.
Entity type:Organization
Organization Name:BERGEN ORTHOPEDICS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/ LICENSED ORTHOTIST
Authorized Official - Prefix:MS
Authorized Official - First Name:ROSARIO
Authorized Official - Middle Name:VICTORIA
Authorized Official - Last Name:CARRAZANA
Authorized Official - Suffix:
Authorized Official - Credentials:LO
Authorized Official - Phone:305-774-7608
Mailing Address - Street 1:4620 NW 7TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33126-2309
Mailing Address - Country:US
Mailing Address - Phone:305-774-7608
Mailing Address - Fax:305-774-7600
Practice Address - Street 1:4620 NW 7TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33126-2309
Practice Address - Country:US
Practice Address - Phone:305-774-7608
Practice Address - Fax:305-774-7600
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLORT 87335E00000X
FLORT 88335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0876790001Medicare NSC