Bergen Spine Associates

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

License

25MB07566200 Issued in NJ

Legal business name

BERGEN SPINE ASSOCIATES

Practice address

50 Clinton PL Ste 6
Hackensack, NJ 07601-4580

Phone

(201) 880-6204

Fax

(201) 880-6206

NPI assigned

Jul 7, 2016

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Roman Kosiborod, M.D.

Title

Medical Director

Phone

(201) 880-6204

Specialties & licenses 1

Addresses

Tax ID family

Bergen Spine Associates2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Bergen Spine Associates Professional Corporation

  • Hospitalist Physician
  • Secaucus, NJ
  • NPI 1477972859
  NPD tax ID

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1467849600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1467849600000",
    "number": "1124470786",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "50 CLINTON PL STE 6",
            "city": "HACKENSACK",
            "state": "NJ",
            "postal_code": "076014580",
            "telephone_number": "201-880-6204",
            "fax_number": "201-880-6206"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "50 CLINTON PL STE 6",
            "city": "HACKENSACK",
            "state": "NJ",
            "postal_code": "076014580",
            "telephone_number": "201-880-6204",
            "fax_number": "201-880-6206"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BERGEN SPINE ASSOCIATES",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-07-07",
        "last_updated": "2016-07-07",
        "status": "A",
        "authorized_official_last_name": "KOSIBOROD",
        "authorized_official_first_name": "ROMAN",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "201-880-6204",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "NJ",
            "license": "25MB07566200",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Bergen Post Acute Care, LLC
• Bergen Psychiatric Associates
• Bergen Psychiatric Associates
• Bergen Psychiatric Associates
• Bergen Psychiatric Associates
• Bergen Surgical Specialists, PA
• Bergen Urological Associates,PA
• Bergen Volunteer Medical Initiative
• Bergen Women'S and Adolescent Care, LLC
• Bergen'S Promise, Inc.

• All providers in Hackensack, NJ
• Primary Care Clinic/Center in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 7, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.