Provider Demographics
NPI:1790752426
Name:BERGEN ORTHOPAEDIC SURGERY & SPORTS MEDICINE
Entity type:Organization
Organization Name:BERGEN ORTHOPAEDIC SURGERY & SPORTS MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:MERVYN
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-666-0013
Mailing Address - Street 1:235 CLOSTER DOCK ROAD
Mailing Address - Street 2:
Mailing Address - City:CLOSTER
Mailing Address - State:NJ
Mailing Address - Zip Code:07624-1947
Mailing Address - Country:US
Mailing Address - Phone:201-666-0013
Mailing Address - Fax:877-547-5841
Practice Address - Street 1:235 CLOSTER DOCK ROAD
Practice Address - Street 2:
Practice Address - City:CLOSTER
Practice Address - State:NJ
Practice Address - Zip Code:07624-1947
Practice Address - Country:US
Practice Address - Phone:201-666-0013
Practice Address - Fax:877-547-5841
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-01
Last Update Date:2025-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
527087Medicare Oscar/Certification
1040110001Medicare NSC