Healthcare Provider Details

I. General information

NPI: 1619153939
Provider Name (Legal Business Name): EMMA L BRYAN DPM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/16/2008
Last Update Date: 09/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29 S NEW YORK RD STE 800
GALLOWAY NJ
08205-9692
US

IV. Provider business mailing address

29 S NEW YORK RD STE 800
GALLOWAY NJ
08205-9692
US

V. Phone/Fax

Practice location:
  • Phone: 609-404-3200
  • Fax: 609-404-4251
Mailing address:
  • Phone: 609-404-3200
  • Fax: 609-404-4251

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License NumberMD0002522
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License NumberMD0002522
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License NumberMD250002522
License Number StateNJ

VIII. Authorized Official

Name: EMMA BRYAN
Title or Position: OWNER
Credential: DPM
Phone: 609-404-3200