Healthcare Provider Details

I. General information

NPI: 1356078976
Provider Name (Legal Business Name): BRITTANY ARIELLE MOK AUD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2022
Last Update Date: 08/03/2022
Certification Date: 08/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 JACK MARTIN BLVD STE 104
BRICK NJ
08724-7737
US

IV. Provider business mailing address

525 JACK MARTIN BLVD STE 104
BRICK NJ
08724-7737
US

V. Phone/Fax

Practice location:
  • Phone: 732-202-0420
  • Fax:
Mailing address:
  • Phone: 732-202-0420
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number41YA00121600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: