1568681112 NPI number — MRS. BRYNANNE ANDERSON MALCOLM DPT

Table of content: MRS. BRYNANNE ANDERSON MALCOLM DPT (NPI 1568681112)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568681112 NPI number — MRS. BRYNANNE ANDERSON MALCOLM DPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MALCOLM
Provider First Name:
BRYNANNE
Provider Middle Name:
ANDERSON
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
DPT
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:
1568681112
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:
1032 WILLOW AVE
Provider Second Line Business Mailing Address:
APARTMENT 1R
Provider Business Mailing Address City Name:
HOBOKEN
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07030-3120
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1032 WILLOW AVE
Provider Second Line Business Practice Location Address:
APARTMENT 1R
Provider Business Practice Location Address City Name:
HOBOKEN
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07030-3120
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
908-233-3720
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/24/2007

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: 225100000X , with the licence number:  40QA01142100 , 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)





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