Provider Demographics
NPI:1225562176
Name:BERGEN NEUROLOGY & PAIN MANAGEMENT LLC
Entity type:Organization
Organization Name:BERGEN NEUROLOGY & PAIN MANAGEMENT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RAVINDER
Authorized Official - Middle Name:
Authorized Official - Last Name:TIKOO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:917-536-8940
Mailing Address - Street 1:209 BENNINGTON TER
Mailing Address - Street 2:
Mailing Address - City:PARAMUS
Mailing Address - State:NJ
Mailing Address - Zip Code:07652-1335
Mailing Address - Country:US
Mailing Address - Phone:917-536-8940
Mailing Address - Fax:
Practice Address - Street 1:480 MARKET ST STE 2
Practice Address - Street 2:
Practice Address - City:SADDLE BROOK
Practice Address - State:NJ
Practice Address - Zip Code:07663-5932
Practice Address - Country:US
Practice Address - Phone:201-250-8088
Practice Address - Fax:201-546-7084
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-18
Last Update Date:2019-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA084336002084N0400X, 2084P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty
No2084P2900XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPain MedicineGroup - Multi-Specialty