Provider Demographics
NPI:1104914712
Name:BERGEN, JAMES T (PA-C)
Entity type:Individual
Prefix:MR
First Name:JAMES
Middle Name:T
Last Name:BERGEN
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Gender:M
Credentials:PA-C
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Mailing Address - Street 1:1 COOPER PLZ
Mailing Address - Street 2:3 DORRANCE
Mailing Address - City:CAMDEN
Mailing Address - State:NJ
Mailing Address - Zip Code:08103-1461
Mailing Address - Country:US
Mailing Address - Phone:856-342-2034
Mailing Address - Fax:856-342-6608
Practice Address - Street 1:3 COOPER PLZ
Practice Address - Street 2:SUITE 311
Practice Address - City:CAMDEN
Practice Address - State:NJ
Practice Address - Zip Code:08103-1438
Practice Address - Country:US
Practice Address - Phone:856-342-2034
Practice Address - Fax:856-342-6608
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2010-09-24
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Provider Licenses
StateLicense IDTaxonomies
NJMP00106363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical