| Bergen Endocrinology, Pc | |
|
12-04 Saddle River Rd Fair Lawn NJ 07410-5811 | |
| (201) 773-8710 | |
| (201) 773-8711 |
| Full Name | Bergen Endocrinology, Pc |
|---|---|
| Speciality | Internal Medicine |
| Location | 12-04 Saddle River Rd, Fair Lawn, New Jersey |
| Authorized Official Name and Position | Dima Yeshou (MD) |
| Authorized Official Contact | 2012817835 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Bergen Endocrinology, Pc 560 Clinton Rd Paramus NJ 07652 Ph: (201) 967-8425 | Bergen Endocrinology, Pc 12-04 Saddle River Rd Fair Lawn NJ 07410-5811 Ph: (201) 773-8710 |
| NPI Number | 1023268976 |
|---|---|
| Provider Enumeration Date | 09/29/2008 |
| Last Update Date | 10/13/2015 |
| Medicare PECOS PAC ID | 7113082066 |
|---|---|
| Medicare Enrollment ID | O20090210000479 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1023268976 | NPI | - | NPPES |
| 0190861 | Medicaid | NJ |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207RE0101X | Internal Medicine - Endocrinology, Diabetes & Metabolism | 25MA08384100 (New Jersey) | Primary |
| Provider Name | Dima Yeshou |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1124287412 PECOS PAC ID: 5294890141 Enrollment ID: I20090210000567 |
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