Healthcare Provider Details

I. General information

NPI: 1114484318
Provider Name (Legal Business Name): BRITTANY CONNOLLY NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/23/2019
Last Update Date: 09/18/2022
Certification Date: 09/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 SUMMIT AVE
MONTVALE NJ
07645-1523
US

IV. Provider business mailing address

33 MOORE ST
STATEN ISLAND NY
10306-1641
US

V. Phone/Fax

Practice location:
  • Phone: 201-775-7000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number343386
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: