NPIMap

Organization Active NPI

Bergen Medical Sports & Spine, Inc.

  • Sports Medicine (Family Medicine) Physician
  • Paramus, NJ
National Provider Identifier
1962722595
Registry record updated Jun 5, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Sports Medicine (Family Medicine) PhysicianTaxonomy code 207QS0010X
License
MA55527 Issued in NJ
Legal business name
BERGEN MEDICAL SPORTS & SPINE, INC.
Practice address
1 Sears Dr
Third Floor
Paramus, NJ 07652-3515
Phone
(201) 261-5220
Fax
(201) 261-5223
NPI assigned
Jun 5, 2010
Last updated
Jun 5, 2010By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 5, 2010

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

Authorized official

Name
Dr. Gary Steven Herring, M.D.NPI 1669576187
Title
President
Phone
(201) 888-0021

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Sports Medicine (Family Medicine) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207QS0010X MA55527 NJ Primary

Addresses

Primary practice location

1 Sears Dr
Third Floor
Paramus, NJ 07652-3515

Mailing address

131 Craig Rd
Hillsdale, NJ 07642-1054
Phone (201) 888-0021

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20101116000078 NJ Part B Supplier - Clinic/Group Practice 8022203033 Receives reassigned benefits from 20 practitioners
Practice locations: Bayonne, NJ; Paramus, NJ; West Orange, NJ

National Provider Directory

National Provider Directory

Locations

10 E 22nd St
Bayonne, NJ 07002
Phone (201) 339-8889

1 Sears Dr
Ste 305
Paramus, NJ 07652
Phone (201) 261-5220

405 Northfield Ave
Ste 102
West Orange, NJ 07052
Phone (973) 321-7889

Practitioners & affiliated clinicians

Practitioners 21

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 21

NPI Registry JSON

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

{
    "created_epoch": "1275696000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1275696000000",
    "number": "1962722595",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "131 CRAIG RD",
            "city": "HILLSDALE",
            "state": "NJ",
            "postal_code": "076421054",
            "telephone_number": "201-888-0021",
            "fax_number": "201-722-3560"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 SEARS DR",
            "address_2": "THIRD FLOOR",
            "city": "PARAMUS",
            "state": "NJ",
            "postal_code": "076523515",
            "telephone_number": "201-261-5220",
            "fax_number": "201-261-5223"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BERGEN MEDICAL SPORTS & SPINE, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-06-05",
        "last_updated": "2010-06-05",
        "status": "A",
        "authorized_official_last_name": "HERRING",
        "authorized_official_first_name": "GARY",
        "authorized_official_middle_name": "STEVEN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "201-888-0021",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207QS0010X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine, Sports Medicine",
            "state": "NJ",
            "license": "MA55527",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Paramus, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 5, 2010; 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.