Provider Demographics
NPI:1861065005
Name:BERGEN COUNTY IMPROVEMENT AUTHORITY
Entity type:Organization
Organization Name:BERGEN COUNTY IMPROVEMENT AUTHORITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:MOLLAHAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-967-4665
Mailing Address - Street 1:230 E RIDGEWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:PARAMUS
Mailing Address - State:NJ
Mailing Address - Zip Code:07652-4142
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:230 E RIDGEWOOD AVE
Practice Address - Street 2:
Practice Address - City:PARAMUS
Practice Address - State:NJ
Practice Address - Zip Code:07652-4142
Practice Address - Country:US
Practice Address - Phone:201-967-4000
Practice Address - Fax:201-225-4776
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BERGEN NEW BRIDGE MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-07-23
Last Update Date:2021-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ10201ADMedicaid