1770784258 NPI number — MR. BRADFORD DOUGLAS KRILL MSW, LCSW

Table of content: (NPI 1831609072)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770784258 NPI number — MR. BRADFORD DOUGLAS KRILL MSW, LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KRILL
Provider First Name:
BRADFORD
Provider Middle Name:
DOUGLAS
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
MSW, LCSW
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:
1770784258
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:
65 LIVINGSTON AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LYNDHURST
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07071-1001
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
908-256-3263
Provider Business Mailing Address Fax Number:
201-355-8270

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
20 WILSEY SQ
Provider Second Line Business Practice Location Address:
SUITE C.
Provider Business Practice Location Address City Name:
RIDGEWOOD
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07450-3793
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
201-445-1068
Provider Business Practice Location Address Fax Number:
201-445-7995
Provider Enumeration Date:
05/30/2007

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: 1041C0700X , with the licence number:  44SC05308600 , 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)





Copyright © 2007-2025 www.npivalidator.com