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NPI Code Detail

MEDICARE: BRIAN BECHTOLD

MEDICARE:   BRIAN  BECHTOLD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363A00000XPhysician Assistant25MP00144200NJ

General Provider Information

NPI Number : 1003882598
Entity Type Code : Individual
Provider Name (Legal Business Name) : BRIAN BECHTOLD
Provider Business Mailing Address
First Line : 103 RIVER RD
Second Line :
City : EDGEWATER
State : NJ
Zip : 07020-1010
Country : US
Telephone Number : 201-941-8100
Fax Number : 201-941-2899
Provider Business Practice Location Address
First Line : 103 RIVER RD
Second Line :
City : EDGEWATER
State : NJ
Zip : 07020-1010
Country : US
Telephone Number : 201-941-8100
Fax Number : 201-941-2899
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/24/2006
Last Update Date : 04/15/2008

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Directions to “ BRIAN BECHTOLD ” Practice Location

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