Basic Information
| Provider Information | |||||||||
| NPI: | 1588224018 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BERGEN INFECTIOUS DISEASES ASSOCIATES INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 110 CHESTNUT RIDGE RD # 337 | ||||||||
| Address2: | |||||||||
| City: | MONTVALE | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 076451706 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2013002768 | ||||||||
| FaxNumber: | 9733588343 | ||||||||
| Practice Location | |||||||||
| Address1: | 185 CEDAR LN STE U8 | ||||||||
| Address2: | |||||||||
| City: | TEANECK | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 076664303 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2013002768 | ||||||||
| FaxNumber: | 9733588343 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/17/2019 | ||||||||
| LastUpdateDate: | 06/17/2019 | ||||||||
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| AuthorizedOfficialLastName: | KHADKA KUNWAR | ||||||||
| AuthorizedOfficialFirstName: | ERINA | ||||||||
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| AuthorizedOfficialTitleorPosition: | PHYSICIAN | ||||||||
| AuthorizedOfficialTelephone: | 2013002768 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RI0200X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Infectious Disease |
No ID Information.