Healthcare Provider Details

I. General information

NPI: 1861804296
Provider Name (Legal Business Name): BRIDGET ECCLES MA INTERN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/20/2014
Last Update Date: 05/20/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 N BRIDGE ST
BRIDGEWATER NJ
08807-2135
US

IV. Provider business mailing address

500 N BRIDGE ST
BRIDGEWATER NJ
08807-2135
US

V. Phone/Fax

Practice location:
  • Phone: 908-725-2800
  • Fax:
Mailing address:
  • Phone: 908-725-2800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: