Organization
BERGEN GASTROENTEROLOGY P C
Active
Parent organization
MEDVANTX, INC.
Other names
Bergen Gastroenterology P.C. - Emerson
Organization subpart
Yes
Provider details
NPI number
Legal business name
MEDVANTX, INC.
Authorized official
KENNY HEINE (VP OF OPERATIONS)
(858) 964-1506
Entity
Organization
Contact information
Practice address
466 OLD HOOK RD, SUITE 1, EMERSON, NJ 07630-1396
(201) 967-8221
Mailing address
5626 OBERLIN DR, SUITE 110, SAN DIEGO, CA 92121-1705
Taxonomy
Speciality
Code
Description
License number
State
332900000X
Non-Pharmacy Dispensing Site
Primary
25MA05477400
NJ
Other
Enumeration date
05/28/2013
Last updated
05/28/2013
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