Healthcare Provider Details

I. General information

NPI: 1417960238
Provider Name (Legal Business Name): BRYAN T HO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2006
Last Update Date: 10/29/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

216 ENGLE ST STE 101
ENGLEWOOD NJ
07631
US

IV. Provider business mailing address

216 ENGLE ST STE 101
ENGLEWOOD NJ
07631
US

V. Phone/Fax

Practice location:
  • Phone: 201-816-9800
  • Fax: 201-567-1569
Mailing address:
  • Phone: 201-816-9800
  • Fax: 201-567-1569

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number25MA06531200
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: