Provider Demographics
NPI:1962722595
Name:BERGEN MEDICAL SPORTS & SPINE, INC.
Entity type:Organization
Organization Name:BERGEN MEDICAL SPORTS & SPINE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:STEVEN
Authorized Official - Last Name:HERRING
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-888-0021
Mailing Address - Street 1:131 CRAIG RD
Mailing Address - Street 2:
Mailing Address - City:HILLSDALE
Mailing Address - State:NJ
Mailing Address - Zip Code:07642-1054
Mailing Address - Country:US
Mailing Address - Phone:201-888-0021
Mailing Address - Fax:201-722-3560
Practice Address - Street 1:1 SEARS DR
Practice Address - Street 2:THIRD FLOOR
Practice Address - City:PARAMUS
Practice Address - State:NJ
Practice Address - Zip Code:07652-3515
Practice Address - Country:US
Practice Address - Phone:201-261-5220
Practice Address - Fax:201-261-5223
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-05
Last Update Date:2010-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA55527207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports MedicineGroup - Multi-Specialty