Bergen Psychiatric Care LLC

Primary specialty

Child & Adolescent Psychiatry PhysicianTaxonomy code 2084P0804X

Legal business name

BERGEN PSYCHIATRIC CARE LLC

Practice address

65 N Maple Ave Ste 104
Ridgewood, NJ 07450-3233

Phone

(201) 956-9483

Fax

(201) 288-5262

NPI assigned

Jun 21, 2017

Organization subpart

No

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

Authorized official

Name

Mini Thomas, MBBS

Title

CCRP

Phone

(201) 956-9483

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in NJ

Enrollment records 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Manoj Puthiyathu

  • Child & Adolescent Psychiatry Physician
  • Paramus, NJ
  • NPI 1649408956

  Child & Adolescent Psychiatry, NJ

  Medicare reassignment NPD

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

{
    "created_epoch": "1498003200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1552867200000",
    "number": "1295255149",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "65 N MAPLE AVE STE 104",
            "city": "RIDGEWOOD",
            "state": "NJ",
            "postal_code": "074503233",
            "telephone_number": "201-956-9483",
            "fax_number": "201-288-5262"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "65 N MAPLE AVE STE 104",
            "city": "RIDGEWOOD",
            "state": "NJ",
            "postal_code": "074503233",
            "telephone_number": "201-956-9483",
            "fax_number": "201-288-5262"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BERGEN PSYCHIATRIC CARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-06-21",
        "last_updated": "2019-03-18",
        "status": "A",
        "authorized_official_last_name": "THOMAS",
        "authorized_official_first_name": "MINI",
        "authorized_official_title_or_position": "CCRP",
        "authorized_official_telephone_number": "201-956-9483",
        "authorized_official_credential": "MBBS"
    },
    "taxonomies": [
        {
            "code": "2084A0401X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Addiction Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2084P0804X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENCE",
            "identifier": "25MA09523700",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Andrew Shaw Benotakeia, MD
• Lynn Benson, MSW
• Eric Y. Bentolila, MD
• Bergen Anesthesia Group, P.C.
• Bergen Dermatology Specialists PA
• Bergen Spine and Sport, LLC
• Bergen Valley Acupuncture
• Flora L Bernard, LCSW
• Joshua William Bernheim, M.D.
• Jill Bernice-Woehrle, LPN

• All providers in Ridgewood, NJ
• Child & Adolescent Psychiatry Physician in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 18, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.