1730365412 NPI number — MR. ALAN LOUIS BRYSKI PHYSICIAN ASSISTANT

Table of content: MR. ALAN LOUIS BRYSKI PHYSICIAN ASSISTANT (NPI 1730365412)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730365412 NPI number — MR. ALAN LOUIS BRYSKI PHYSICIAN ASSISTANT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BRYSKI
Provider First Name:
ALAN
Provider Middle Name:
LOUIS
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
PHYSICIAN ASSISTANT
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:
1730365412
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/03/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1830
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ALLENTOWN
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18105-1830
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
484-862-3193
Provider Business Mailing Address Fax Number:
484-664-7659

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1251 S CEDAR CREST BLVD STE 202A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ALLENTOWN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18103-6214
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-402-5766
Provider Business Practice Location Address Fax Number:
610-402-5763
Provider Enumeration Date:
01/13/2008

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: 363AM0700X , with the licence number:  MA-000174-L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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