1104812718 NPI number — MS. SUSAN JEAN BRILLHART MSN, RN, BC, CPNP

Table of content: MS. SUSAN JEAN BRILLHART MSN, RN, BC, CPNP (NPI 1104812718)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104812718 NPI number — MS. SUSAN JEAN BRILLHART MSN, RN, BC, CPNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BRILLHART
Provider First Name:
SUSAN
Provider Middle Name:
JEAN
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
MSN, RN, BC, CPNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1104812718
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
515 PARK AVE
Provider Second Line Business Mailing Address:
1G
Provider Business Mailing Address City Name:
HOBOKEN
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07030-6912
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
201-420-6963
Provider Business Mailing Address Fax Number:
212-748-7457

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
199 CHAMBERS ST
Provider Second Line Business Practice Location Address:
S-782 BMCC
Provider Business Practice Location Address City Name:
NEW YORK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10007-1044
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
917-273-7726
Provider Business Practice Location Address Fax Number:
212-748-7457
Provider Enumeration Date:
09/20/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 163WP0200X , with the licence number:  368209 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 163WP0200X , with the licence number: 26NR06786500 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 363LP0200X , with the licence number: F380906 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 363LP0200X , with the licence number: 26NN06786500 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

Other Provider's Identifiers (legacy, non-NPI)