Healthcare Provider Details

I. General information

NPI: 1679038723
Provider Name (Legal Business Name): MS. MEGYN LEIGH BEREZNY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/04/2019
Last Update Date: 02/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

630 WATER ST
BELVIDERE NJ
07823-1312
US

IV. Provider business mailing address

630 WATER ST
BELVIDERE NJ
07823-1312
US

V. Phone/Fax

Practice location:
  • Phone: 908-319-1396
  • Fax:
Mailing address:
  • Phone: 908-319-1396
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: