Provider Demographics
NPI:1699048322
Name:BERGENLINE SPINE AND HEALTHCARE CENTER PC
Entity type:Organization
Organization Name:BERGENLINE SPINE AND HEALTHCARE CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:WOHL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:201-758-0099
Mailing Address - Street 1:PO BOX 5262
Mailing Address - Street 2:
Mailing Address - City:WEST NEW YORK
Mailing Address - State:NJ
Mailing Address - Zip Code:07093-9262
Mailing Address - Country:US
Mailing Address - Phone:201-758-0099
Mailing Address - Fax:201-758-2992
Practice Address - Street 1:6000 KENNEDY BLVD W
Practice Address - Street 2:
Practice Address - City:WEST NEW YORK
Practice Address - State:NJ
Practice Address - Zip Code:07093-1414
Practice Address - Country:US
Practice Address - Phone:201-758-0099
Practice Address - Fax:201-758-2992
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-10
Last Update Date:2013-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
111N00000X, 207LP2900X, 207R00000X, 207X00000X, 208100000X, 208VP0014X
NJ25MZ00059400171100000X
NJ40QA00729000225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty