Organization Active NPI

Bergen Optometry, LLC

  • Optometrist
  • Hackensack, NJ
National Provider Identifier
1780044958
Registry record updated Nov 13, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
Legal business name
BERGEN OPTOMETRY, LLC
Practice address
348 Main St
Hackensack, NJ 07601-5803
Phone
(201) 342-4255
Fax
(201) 487-4886
NPI assigned
Mar 2, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 13, 2018

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

Authorized official

Name
Joie Brody-Sendroff, OD
Title
Owner
Phone
(201) 342-4255

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193400000X SINGLE SPECIALTY GROUP 152W00000X 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

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20161107000749 NJ Part B Supplier - Clinic/Group Practice 2062790439 Receives reassigned benefits from 5 practitioners
Practice locations: Hackensack, NJ

National Provider Directory

National Provider Directory

Locations

348 Main St
Hackensack, NJ 07601
Phone (201) 342-2767

Practitioners & affiliated clinicians

Practitioners 7

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": "1456876800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1542067200000",
    "number": "1780044958",
    "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, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-03-02",
        "last_updated": "2018-11-13",
        "status": "A",
        "authorized_official_last_name": "BRODY-SENDROFF",
        "authorized_official_first_name": "JOIE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "201-342-4255",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "NJ",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "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 Nov 13, 2018; 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.