| Bergenline Family Medicine | |
|
333 60th St West New York NJ 07093-5487 | |
| (201) 453-8777 | |
| (201) 453-8804 |
| Full Name | Bergenline Family Medicine |
|---|---|
| Speciality | Clinic/Center |
| Location | 333 60th St, West New York, New Jersey |
| Authorized Official Name and Position | Gil V. Fajardo (DIRECTOR) |
| Authorized Official Contact | 2014538777 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Bergenline Family Medicine 333 60th St West New York NJ 07093-5487 Ph: (201) 453-8777 | Bergenline Family Medicine 333 60th St West New York NJ 07093-5487 Ph: (201) 453-8777 |
| NPI Number | 1811207475 |
|---|---|
| Provider Enumeration Date | 10/18/2010 |
| Last Update Date | 01/04/2011 |
| Medicare PECOS PAC ID | 3476732041 |
|---|---|
| Medicare Enrollment ID | O20110128000005 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1811207475 | NPI | - | NPPES |
| G37823 | Other | NJ | UPIN |
| 7003803 | Medicaid | NJ |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | MA062055 (New Jersey) | Primary |
| Provider Name | Gil V Fajardo |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1336226463 PECOS PAC ID: 4385823954 Enrollment ID: I20110128000007 |
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