Active NPI
Siddhi Ganesha Inc
Doing business as Bergen Pharmacy
- Community/Retail Pharmacy
- Elizabeth, NJ
National Provider Identifier
1841782752
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Community/Retail Pharmacy
- License
- 28RS00764500
- Legal business name
- SIDDHI GANESHA INC
- Doing business as
- Bergen Pharmacy
- Practice address
- 655 E Jersey St
Elizabeth, NJ 07206-1259 - Phone
- (908) 994-9300
- Fax
- (908) 994-9305
- NPI assigned
- Jun 6, 2018
- Last updated
- Jul 21, 2020
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Devang Rasik Nagrecha
- Title
- President
- Phone
- (973) 632-4994
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacy | 333600000X | NU | ||
| Community/Retail Pharmacy | 3336C0003X | 28RS00764500 | NJ | Primary |
Addresses
Primary practice location
655 E Jersey St
Elizabeth, NJ 07206-1259
Mailing address
23 Canoe Brook Dr
Livingston, NJ 07039-6121
Phone (973) 632-4994
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2177999 | Other | PK |
Other names 1
- BERGEN PHARMACY
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NJ
Enrollment records 2
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20210106000636 | NJ | Part B Supplier - Pharmacy | 5092128314 | Practice locations: Elizabeth, NJ |
| O20211001000381 | NJ | DME Supplier - Pharmacy | 5092128314 | Practice locations: Elizabeth, NJ |
National Provider Directory
National Provider Directory- Tax ID family
- Bergen Pharmacy
Other organizations with this tax ID 1
Organizations that report the same tax identification number in the National Provider Directory.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1528243200000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1595289600000",
"number": "1841782752",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "23 CANOE BROOK DR",
"city": "LIVINGSTON",
"state": "NJ",
"postal_code": "070396121",
"telephone_number": "973-632-4994"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "655 E JERSEY ST",
"city": "ELIZABETH",
"state": "NJ",
"postal_code": "072061259",
"telephone_number": "908-994-9300",
"fax_number": "908-994-9305"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "SIDDHI GANESHA INC",
"organizational_subpart": "NO",
"enumeration_date": "2018-06-06",
"last_updated": "2020-07-21",
"certification_date": "2020-07-21",
"status": "A",
"authorized_official_last_name": "NAGRECHA",
"authorized_official_first_name": "DEVANG",
"authorized_official_middle_name": "RASIK",
"authorized_official_title_or_position": "PRESIDENT",
"authorized_official_telephone_number": "973-632-4994"
},
"taxonomies": [
{
"code": "333600000X",
"taxonomy_group": "",
"desc": "Pharmacy",
"state": "NU",
"license": null,
"primary": false
},
{
"code": "3336C0003X",
"taxonomy_group": "",
"desc": "Pharmacy, Community/Retail Pharmacy",
"state": "NJ",
"license": "28RS00764500",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PK",
"identifier": "2177999",
"state": null
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "BERGEN PHARMACY",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Elizabeth, NJ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2020; 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.