1437592946 NPI number — DR. BRETT BIELORY M.D.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437592946 NPI number — DR. BRETT BIELORY M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BIELORY
Provider First Name:
BRETT
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

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:
1437592946
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/13/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
100 WOODS RD
Provider Second Line Business Mailing Address:
MACY PAVILION ROOM 1044
Provider Business Mailing Address City Name:
VALHALLA
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10595-1530
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
914-493-7671
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
201 17 NORTH
Provider Second Line Business Practice Location Address:
SUITE 1202
Provider Business Practice Location Address City Name:
RUTHERFORD
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07070
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
551-257-7001
Provider Business Practice Location Address Fax Number:
551-257-7002
Provider Enumeration Date:
04/15/2013

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: 207W00000X , with the licence number:  25MA09617200 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: BB3232267556 . This is a "BB3232267556" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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