NPIMap

Organization Active NPI

Bergen Optometry Group, PA

  • Optometrist
  • Hackensack, NJ
National Provider Identifier
1679634208
Registry record updated Apr 21, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
27TO00046002 Issued in NJ
Legal business name
BERGEN OPTOMETRY GROUP, PA
Practice address
348 Main St
Hackensack, NJ 07601-5803
Phone
(201) 342-4255
Fax
(201) 487-4886
NPI assigned
Dec 13, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 21, 2016

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

Authorized official

Name
Dr. Steven L Ehrenworth, O.D.
Title
Optometrist
Phone
(201) 342-4255

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193400000X SINGLE SPECIALTY GROUP 152W00000X 27TO00046002 NJ Primary

Addresses

Primary practice location

348 Main St
Hackensack, NJ 07601-5803

Mailing address

348 Main St
Hackensack, NJ 07601-5803
Phone (201) 342-4255

Other identifiers 1

IdentifierTypeStateIssuer
295909MedicaidNJ

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 9

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

NPI Registry JSON

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

{
    "created_epoch": "1165968000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1461196800000",
    "number": "1679634208",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "348 MAIN ST",
            "city": "HACKENSACK",
            "state": "NJ",
            "postal_code": "076015803",
            "telephone_number": "201-342-4255",
            "fax_number": "201-487-4886"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "348 MAIN ST",
            "city": "HACKENSACK",
            "state": "NJ",
            "postal_code": "076015803",
            "telephone_number": "201-342-4255",
            "fax_number": "201-487-4886"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BERGEN OPTOMETRY GROUP, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-13",
        "last_updated": "2016-04-21",
        "status": "A",
        "authorized_official_last_name": "EHRENWORTH",
        "authorized_official_first_name": "STEVEN",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "OPTOMETRIST",
        "authorized_official_telephone_number": "201-342-4255",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "NJ",
            "license": "27TO00046002",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "295909",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Hackensack, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 21, 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.