Provider Demographics
NPI:1174728406
Name:COUNTY OF BERGEN N J
Entity type:Organization
Organization Name:COUNTY OF BERGEN N J
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:S
Authorized Official - Last Name:CONDAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-634-2680
Mailing Address - Street 1:327 E RIDGEWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:PARAMUS
Mailing Address - State:NJ
Mailing Address - Zip Code:07652-4819
Mailing Address - Country:US
Mailing Address - Phone:201-634-2680
Mailing Address - Fax:
Practice Address - Street 1:327 E RIDGEWOOD AVE
Practice Address - Street 2:
Practice Address - City:PARAMUS
Practice Address - State:NJ
Practice Address - Zip Code:07652-4819
Practice Address - Country:US
Practice Address - Phone:201-634-2680
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-18
Last Update Date:2008-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ765812Medicare PIN
NJ118561Medicare PIN