Provider Demographics
NPI:1699589382
Name:BERGEN ENTERPRISES CENTER LLC
Entity type:Organization
Organization Name:BERGEN ENTERPRISES CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:JAY
Authorized Official - Middle Name:
Authorized Official - Last Name:JONAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-321-4716
Mailing Address - Street 1:22-08 ROUTE 208 STE 2
Mailing Address - Street 2:
Mailing Address - City:FAIR LAWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07410-2609
Mailing Address - Country:US
Mailing Address - Phone:201-321-4716
Mailing Address - Fax:888-465-3829
Practice Address - Street 1:757 PALISADE AVE
Practice Address - Street 2:
Practice Address - City:CLIFFSIDE PARK
Practice Address - State:NJ
Practice Address - Zip Code:07010-3204
Practice Address - Country:US
Practice Address - Phone:201-321-4716
Practice Address - Fax:888-465-3829
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BERGEN ENTERPRISES CENTER LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-02-04
Last Update Date:2025-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder