Provider Demographics
NPI:1144730987
Name:BERGEN BARIATRIC AND SURGICAL SOLUTIONS PC
Entity type:Organization
Organization Name:BERGEN BARIATRIC AND SURGICAL SOLUTIONS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MIKHAIL
Authorized Official - Middle Name:A
Authorized Official - Last Name:BOTVINOV
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:201-693-2653
Mailing Address - Street 1:23 ROBYN CT
Mailing Address - Street 2:
Mailing Address - City:EMERSON
Mailing Address - State:NJ
Mailing Address - Zip Code:07630-1464
Mailing Address - Country:US
Mailing Address - Phone:201-778-5344
Mailing Address - Fax:201-778-5399
Practice Address - Street 1:260 OLD HOOK ROAD,
Practice Address - Street 2:SUITE 303A
Practice Address - City:WESTWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07675-3123
Practice Address - Country:US
Practice Address - Phone:201-778-5344
Practice Address - Fax:201-778-5399
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-06
Last Update Date:2020-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty