Provider Demographics
NPI:1699960492
Name:BERGENFIELD MEDICAL ARTS, PA
Entity type:Organization
Organization Name:BERGENFIELD MEDICAL ARTS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:BONNIE
Authorized Official - Middle Name:
Authorized Official - Last Name:DIAMOND
Authorized Official - Suffix:
Authorized Official - Credentials:ED D
Authorized Official - Phone:201-384-9255
Mailing Address - Street 1:205 N WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:BERGENFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07621-1359
Mailing Address - Country:US
Mailing Address - Phone:201-384-9255
Mailing Address - Fax:201-384-2758
Practice Address - Street 1:205 N WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:BERGENFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07621-1359
Practice Address - Country:US
Practice Address - Phone:201-384-9255
Practice Address - Fax:201-384-2758
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-14
Last Update Date:2007-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty