bergenphysicalmedicine.com
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184.106.55.134
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Submitted URL: https://www.bergenphysicalmed.com/
Effective URL: https://bergenphysicalmedicine.com/
Submission: On December 12 via api from US — Scanned from DE
Effective URL: https://bergenphysicalmedicine.com/
Submission: On December 12 via api from US — Scanned from DE
Form analysis 4 forms found in the DOM
POST /cms/mailer/send/send906
<form method="post" action="/cms/mailer/send/send906">
<div class="animateMe animated fadeInUp" data-animation="fadeInUp">
<div class="form-group">
<label class="sr-only" for="nyship_first_name">First Name</label>
<input type="text" class="form-control" id="nyship_first_name" name="first_name" placeholder="First Name">
</div>
</div>
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<div class="form-group">
<label class="sr-only" for="nyship_last_name">Last Name</label>
<input type="text" class="form-control" id="nyship_last_name" name="last_name" placeholder="Last Name">
</div>
</div>
<div class="animateMe animated fadeInUp" data-animation="fadeInUp">
<div class="form-group">
<label class="sr-only" for="nyship_dob">Date of Birth</label>
<input type="text" class="form-control" id="nyship_dob" name="date_of_birth" placeholder="Date of Birth">
</div>
</div>
<div class="animateMe animated fadeInUp" data-animation="fadeInUp">
<div class="form-group">
<label class="sr-only" for="nyship_phone">Phone</label>
<input type="text" class="form-control" id="nyship_phone" name="phone" placeholder="Phone">
</div>
</div>
<div class="animateMe animated fadeInUp" data-animation="fadeInUp">
<div class="form-group">
<label class="sr-only" for="nyship_email">Email</label>
<input type="email" class="form-control" id="nyship_email" name="email" placeholder="Email">
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</div>
<div class="animateMe animated fadeInUp" data-animation="fadeInUp">
<div class="form-group">
<label class="sr-only" for="nyship_address">Address</label>
<input type="text" class="form-control" id="nyship_address" name="address" placeholder="Address">
</div>
</div>
<div class="animateMe animated fadeInUp" data-animation="fadeInUp">
<div class="form-group">
<label class="sr-only" for="nyship_city">City</label>
<input type="text" class="form-control" id="nyship_city" name="city" placeholder="City">
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</div>
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<div class="col-8">
<label class="sr-only" for="nyship_state">State</label>
<select class="form-control" id="nyship_state" name="state" placeholder="State">
<option value="">Select State</option>
<option value="AL">Alabama</option>
<option value="AK">Alaska</option>
<option value="AZ">Arizona</option>
<option value="AR">Arkansas</option>
<option value="CA">California</option>
<option value="CO">Colorado</option>
<option value="CT">Connecticut</option>
<option value="DE">Delaware</option>
<option value="DC">District Of Columbia</option>
<option value="FL">Florida</option>
<option value="GA">Georgia</option>
<option value="HI">Hawaii</option>
<option value="ID">Idaho</option>
<option value="IL">Illinois</option>
<option value="IN">Indiana</option>
<option value="IA">Iowa</option>
<option value="KS">Kansas</option>
<option value="KY">Kentucky</option>
<option value="LA">Louisiana</option>
<option value="ME">Maine</option>
<option value="MD">Maryland</option>
<option value="MA">Massachusetts</option>
<option value="MI">Michigan</option>
<option value="MN">Minnesota</option>
<option value="MS">Mississippi</option>
<option value="MO">Missouri</option>
<option value="MT">Montana</option>
<option value="NE">Nebraska</option>
<option value="NV">Nevada</option>
<option value="NH">New Hampshire</option>
<option value="NJ">New Jersey</option>
<option value="NM">New Mexico</option>
<option value="NY">New York</option>
<option value="NC">North Carolina</option>
<option value="ND">North Dakota</option>
<option value="OH">Ohio</option>
<option value="OK">Oklahoma</option>
<option value="OR">Oregon</option>
<option value="PA">Pennsylvania</option>
<option value="RI">Rhode Island</option>
<option value="SC">South Carolina</option>
<option value="SD">South Dakota</option>
<option value="TN">Tennessee</option>
<option value="TX">Texas</option>
<option value="UT">Utah</option>
<option value="VT">Vermont</option>
<option value="VA">Virginia</option>
<option value="WA">Washington</option>
<option value="WV">West Virginia</option>
<option value="WI">Wisconsin</option>
<option value="WY">Wyoming</option>
</select>
</div>
<div class="col-4">
<label class="sr-only" for="nyship_zip">Zip</label>
<input type="text" class="form-control" id="nyship_zip" name="zip" placeholder="Zip">
</div>
</div>
</div>
<div class="animateMe animated fadeInUp" data-animation="fadeInUp">
<div class="form-group">
<label class="sr-only" for="nyship_insurance_id">Insurance ID</label>
<input type="text" class="form-control" id="nyship_insurance_id" name="insurance_id" placeholder="Insurance ID">
</div>
</div>
<div class="animateMe animated fadeInUp" data-animation="fadeInUp">
<div class="form-group">
<label class="sr-only" for="nyship_group_number">Group #</label>
<input type="text" class="form-control" id="nyship_group_number" name="group_number" placeholder="Group#">
</div>
</div>
<div class="animateMe animated fadeInUp" data-animation="fadeInUp">
<div class="form-group">
<script src="https://www.google.com/recaptcha/api.js"></script>
<div class="g-recaptcha" data-sitekey="6Lcjrj4aAAAAAMcHVJY1V_pYw_ZFYd0Z6HCMDgLL">
<div style="width: 304px; height: 78px;">
<div><iframe title="reCAPTCHA" width="304" height="78" role="presentation" name="a-iegsxt3jtz10" frameborder="0" scrolling="no"
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</div>
</div>
</div>
<div class="text-center animateMe animated fadeInUp" data-animation="fadeInUp">
<button type="submit" class="btn btn-primary my-1" id="submit_nyship">Send</button>
<input type="hidden" name="subject" value="[BPM] NYSHIP Submission">
<input type="hidden" name="redirect" value="https://bergenphysicalmedicine.com/">
<input type="hidden" name="recipient" value="info@bergenphysicalmedicine.com">
</div>
</form>POST /cms/subscriber/add
<form class="form" method="post" action="/cms/subscriber/add">
<div class="input-group mb-2 mr-sm-2">
<label for="subscriber_email" class="sr-only">Your Email</label>
<input type="text" class="form-control" id="subscriber_email" placeholder="Your Email" name="email">
<div class="input-group-prepend">
<button type="submit" class="btn btn-white" id="submit_subscribe">Submit</button>
<input type="hidden" name="redirect" value="https://bergenphysicalmedicine.com/">
</div>
</div>
</form>POST /cms/mailer/send/send906
<form method="post" action="/cms/mailer/send/send906">
<div class="row">
<div class="col-md-6 animateMe animated fadeInUp" data-animation="fadeInUp">
<div class="form-group">
<label for="name">Name*</label>
<input type="text" class="form-control" id="name" name="name">
</div>
</div>
<div class="col-md-6 animateMe animated fadeInUp" data-animation="fadeInUp">
<div class="form-group">
<label for="email">Email*</label>
<input type="email" class="form-control" id="email" name="email">
</div>
</div>
<div class="col-12 animateMe animated fadeInUp" data-animation="fadeInUp">
<div class="form-group">
<label for="email">Phone*</label>
<input type="text" class="form-control" id="phone" name="phone">
</div>
</div>
<div class="col-12 animateMe animated fadeInUp" data-animation="fadeInUp">
<div class="form-group">
<label>Message to Doctor*</label>
<textarea class="form-control" id="message" name="message_to_doctor"></textarea>
</div>
</div>
<div class="col-12 animateMe animated fadeInUp" data-animation="fadeInUp">
<div class="form-group">
<script src="https://www.google.com/recaptcha/api.js"></script>
<div class="g-recaptcha" data-sitekey="6Lcjrj4aAAAAAMcHVJY1V_pYw_ZFYd0Z6HCMDgLL">
<div style="width: 304px; height: 78px;">
<div><iframe title="reCAPTCHA" width="304" height="78" role="presentation" name="a-7l4eix221120" frameborder="0" scrolling="no"
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</div><iframe style="display: none;"></iframe>
</div>
</div>
</div>
<div class="col-12 text-center animateMe animated fadeInUp" data-animation="fadeInUp">
<button type="submit" class="btn btn-primary my-1" id="submit_appointment">Send</button>
<input type="hidden" name="subject" value="[BPM] Appointment Request">
<input type="hidden" name="redirect" value="https://bergenphysicalmedicine.com/">
<input type="hidden" name="recipient" value="info@bergenphysicalmedicine.com">
</div>
</div>
</form>POST //translate.googleapis.com/translate_voting?client=te
<form id="goog-gt-votingForm" action="//translate.googleapis.com/translate_voting?client=te" method="post" target="votingFrame" class="VIpgJd-yAWNEb-hvhgNd-aXYTce"><input type="text" name="sl" id="goog-gt-votingInputSrcLang"><input type="text"
name="tl" id="goog-gt-votingInputTrgLang"><input type="text" name="query" id="goog-gt-votingInputSrcText"><input type="text" name="gtrans" id="goog-gt-votingInputTrgText"><input type="text" name="vote" id="goog-gt-votingInputVote"></form>Text Content
* About Us * Dr. Wraith * Facility * Testimonials * Vein Medicine * Services * Chiropractic * Physical Therapy * Accupuncture * Massage Therapy * Spinal Decompression * Injuries * Cryotherapy * Electrical Stimulation * Custom Foot Orthotics * Spinal Adjustments * Therapeutic Exercise * Therapeutic Ultrasound * Vascular * Spinal Wellness * Patient Resources * New Patients * Spinal Wellness Tips * FAQ * Contact Us ENJOY LIFE MORE YOUR PAIN-FREE LIFE, JUST AROUND THE CORNER Make An Appointment PERSONAL INJURY AUTO, WORK, SLIP & FALL Make An Appointment VEIN MEDICINE Make An Appointment * WELCOME Welcome to our practice! We hope that you will find this site helpful in learning more about our office and how all of our physical medicine services can improve your quality of life. By offering physical therapy, chiropractic, massage therapy, acupuncture and spinal decompression in one facility we strive to meet all of your physical medicine needs. We also have digital x-ray services on site for those patients that require x-rays. * COVID-19 In response to recent COVID-19 concerns, we are writing to assure our clients that we are taking recommended precautions. Everyone in our office will be in a mask. All providers will be gloved and constant disinfecting measures will be taken. Make An Appointment PHYSICAL THERPY CHIROPRACTIC MASSAGE THERAPY ACUPUNCTURE Massage Therapy is covered by PPO NYSHIP insurance. Complete your complimentary insurance compatibility. Check Now × Confidential Patient Information For New York State employees with PPO NYSHIP Empire health benefits. Massage Therapy is a covered benefit at our office. If you are interested in massage therapy, please complete the attached form and a member of our staff will perform a complimentary insurance compatibility check and report back to you with the results. First Name Last Name Date of Birth Phone Email Address City State Select State Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Zip Insurance ID Group # Send OFFICE LOCATION 323 Bergen Boulevard Fairview, NJ 07022 201-945-9993 * * HOURS OF OPERATION * Monday - Thursday: 10:00 AM-2:00 PM 3:30 PM-7:00 PM * Friday: 10:00 AM-2:00 PM 3:30 PM-6:00 PM * Saturday: 10:00 AM-2:00 PM * Sunday: Closed SUBSCRIBE TO NEWSLETTER Sign up for BPM newsletter for future updates about our practice. Your Email Submit Select LanguageAfrikaansAlbanianArabicArmenianAzerbaijaniBasqueBelarusianBulgarianCatalanChinese (Simplified)Chinese (Traditional)CroatianCzechDanishDutchEnglishEstonianFilipinoFinnishFrenchGalicianGeorgianGermanGreekHaitian CreoleHebrewHindiHungarianIcelandicIndonesianIrishItalianJapaneseKoreanLatvianLithuanianMacedonianMalayMalteseNorwegianPersianPolishPortugueseRomanianRussianSerbianSlovakSlovenianSpanishSwahiliSwedishThaiTurkishUkrainianUrduVietnameseWelshYiddish Powered by Google Übersetzer MAKE AN APPOINTMENT × Name* Email* Phone* Message to Doctor* Send Originaltext Diese Übersetzung bewerten Mit deinem Feedback können wir Google Übersetzer weiter verbessern What brings you here today? CHAT LIVE NOW