Bergen Gastroenterology P C

Primary specialty

Non-Pharmacy Dispensing SiteTaxonomy code 332900000X

License

25MA05477400 Issued in NJ

Legal business name

BERGEN GASTROENTEROLOGY P C

Practice address

466 Old Hook Rd
Suite 1
Emerson, NJ 07630-1396

Phone

(201) 967-8221

NPI assigned

May 28, 2013

Organization subpart

Yes

Parent organization

MEDVANTX, INC.As reported in NPPES

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

Authorized official

Name

Kenny Heine

Title

VP of Operations

Phone

(858) 964-1506

Specialties & licenses 1

Addresses

Other names 1

• Bergen Gastroenterology P.C. - Emerson Doing business as

Tax ID family

Bergen Gastroenterology PC3 organizations share this tax ID, including this one

Part of

Tri - State Medical Group Inc

Other organizations with this tax ID 2

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

• Bergen Gastroenterology PC

  • Ambulatory Surgical Clinic/Center
  • Emerson, NJ
  • NPI 1447457403
  NPD tax ID
• Bergen Gastroenterology PC

  • Non-Pharmacy Dispensing Site
  • Paramus, NJ
  • NPI 1659799328
  NPD tax ID

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

{
    "created_epoch": "1369699200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1369699200000",
    "number": "1801233176",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5626 OBERLIN DR",
            "address_2": "SUITE 110",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921211705"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "466 OLD HOOK RD",
            "address_2": "SUITE 1",
            "city": "EMERSON",
            "state": "NJ",
            "postal_code": "076301396",
            "telephone_number": "201-967-8221"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BERGEN GASTROENTEROLOGY P C",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MEDVANTX, INC.",
        "enumeration_date": "2013-05-28",
        "last_updated": "2013-05-28",
        "status": "A",
        "authorized_official_last_name": "HEINE",
        "authorized_official_first_name": "KENNY",
        "authorized_official_title_or_position": "VP OF OPERATIONS",
        "authorized_official_telephone_number": "858-964-1506"
    },
    "taxonomies": [
        {
            "code": "332900000X",
            "taxonomy_group": "",
            "desc": "Non-Pharmacy Dispensing Site",
            "state": "NJ",
            "license": "25MA05477400",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Bergen Gastroenterology P.C. - Emerson",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Muhiba Begum, PMHNP-BC
• Alyse R Bellomo, MD
• Ari Ben-Yishay, MD
• Bergen Ambulatory Anesthesia
• Bergen County Family Chiropractic
• Bergen Gastroenterology PC
• Bergen Gastroenterology PC
• Bergen Women OB GYN Assoc
• Nalini Bethala, MD
• Vivian K Bethala, MD

• All providers in Emerson, NJ
• Non-Pharmacy Dispensing Site in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 28, 2013; 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.