Organization
BERGENLINE FAMILY MEDICINE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GIL V. FAJARDO M.D. (DIRECTOR)
(201) 453-8777
Entity
Organization
Contact information
Practice address
333 60TH ST, WEST NEW YORK, NJ 07093-5487
(201) 453-8777
(201) 453-8804
Mailing address
333 60TH ST, WEST NEW YORK, NJ 07093-5487
(201) 453-8777
(201) 453-8804
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
MA062055
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7003803
—
NJ
01
—
G37823
UPIN
NJ
Enumeration date
10/18/2010
Last updated
01/04/2011
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