Healthcare Provider Details

I. General information

NPI: 1063869584
Provider Name (Legal Business Name): HB BRYANT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/16/2016
Last Update Date: 01/26/2024
Certification Date: 01/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 PLAINFIELD AVE SUITE C
EDISON NJ
08817-3172
US

IV. Provider business mailing address

300 PLAINFIELD AVE STE C
EDISON NJ
08817-3172
US

V. Phone/Fax

Practice location:
  • Phone: 973-500-4030
  • Fax:
Mailing address:
  • Phone: 718-787-7442
  • Fax: 973-500-4030

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number44SC05683500
License Number StateNJ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: