Provider Demographics
NPI:1316293996
Name:BERGEN GERIATRIC CARE, LLC
Entity type:Organization
Organization Name:BERGEN GERIATRIC CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ODESSA
Authorized Official - Middle Name:E
Authorized Official - Last Name:HOINKIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-387-2003
Mailing Address - Street 1:680 KINDERKAMACK RD
Mailing Address - Street 2:STE 205
Mailing Address - City:ORADELL
Mailing Address - State:NJ
Mailing Address - Zip Code:07649-1600
Mailing Address - Country:US
Mailing Address - Phone:201-387-2003
Mailing Address - Fax:201-387-2277
Practice Address - Street 1:680 KINDERKAMACK ROAD
Practice Address - Street 2:STE 205
Practice Address - City:ORADELL
Practice Address - State:NJ
Practice Address - Zip Code:07649-1600
Practice Address - Country:US
Practice Address - Phone:201-387-2003
Practice Address - Fax:201-387-2277
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-01
Last Update Date:2012-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB07894000207Q00000X
NJ25MA08487900207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty