Provider Demographics
NPI:1104105717
Name:BERGEN WOMEN'S AND ADOLESCENT CARE, LLC
Entity type:Organization
Organization Name:BERGEN WOMEN'S AND ADOLESCENT CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER/PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:NIKETA
Authorized Official - Middle Name:V
Authorized Official - Last Name:GOVINDANI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-485-8222
Mailing Address - Street 1:PO BOX 1140
Mailing Address - Street 2:
Mailing Address - City:WARWICK
Mailing Address - State:NY
Mailing Address - Zip Code:10990-8140
Mailing Address - Country:US
Mailing Address - Phone:201-688-0823
Mailing Address - Fax:845-544-2201
Practice Address - Street 1:211 ESSEX ST STE 301
Practice Address - Street 2:
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601-3246
Practice Address - Country:US
Practice Address - Phone:551-202-7202
Practice Address - Fax:201-742-5328
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-12
Last Update Date:2019-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07894100207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty