Doctor Name: | HEATHER BRYAN |
NPI Number: | 1376964288 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | |
License Number: | 25MP00320300 |
Business Practice Address: | 663 Palisade Ave Cliffside Park, NJ - 070103012 |
Business Phone Number: | 2019439100 |
Business Fax Number: | 2019437308 |
Mailing Address: | 111 Galway Pl, TEANECK |
State: | NJ |
Postal Code: | 076663640 |
Phone Number: | 2018339500 |
Fax Number: | 2018620095 |
NPI Enumeration Date: | 12/18/2013 |
NPI Last Update Date: | 12/18/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363AS0400X |
License Number: | 25MP00320300 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NJ |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Physician Assistant |
Taxonomy Specialization: | Surgical |
Taxonomy Definition: |