| Organization Name: | SPORTS MEDICINE CENTER OF BERGEN, PA |
| NPI Number: | 1154595197 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | GARY FLINK (VICE PRESIDENT) |
| Mailing Address: | 136 Hopper Ave. Waldwick |
| State: | NJ US |
| Postal Code: | 07463 |
| Phone Number: | 2014880488 |
| Fax Number: | |
| NPI Enumeration Date: | 04/22/2008 |
| NPI Last Update Date: | 05/24/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 2251S0007X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NJ |
| Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Taxonomy Classification: | Physical Therapist |
| Taxonomy Specialization: | Sports |
| Taxonomy Definition: | |