Healthcare Provider Details

I. General information

NPI: 1619837507
Provider Name (Legal Business Name): BROWNRIDGE BROKERING GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/13/2025
Last Update Date: 11/13/2025
Certification Date: 11/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

560 HUDSON ST STE 301
HACKENSACK NJ
07601-6655
US

IV. Provider business mailing address

560 HUDSON ST STE 301
HACKENSACK NJ
07601-6655
US

V. Phone/Fax

Practice location:
  • Phone: 862-203-9477
  • Fax: 212-888-6024
Mailing address:
  • Phone: 862-203-9477
  • Fax: 212-888-6024

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171W00000X
TaxonomyContractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: BERNARR D BROWNRIDGE
Title or Position: PRESIDENT
Credential:
Phone: 862-203-9477