Provider Demographics
NPI:1053541599
Name:OLD BERGEN PEDIATRICS PA
Entity type:Organization
Organization Name:OLD BERGEN PEDIATRICS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EDUARDO
Authorized Official - Middle Name:
Authorized Official - Last Name:MANGOSING
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-434-3997
Mailing Address - Street 1:4 HIGHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07306-4510
Mailing Address - Country:US
Mailing Address - Phone:201-434-3997
Mailing Address - Fax:201-434-3304
Practice Address - Street 1:4 HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07306-4510
Practice Address - Country:US
Practice Address - Phone:201-434-3997
Practice Address - Fax:201-434-3304
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-17
Last Update Date:2009-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06888600208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty