Healthcare Provider Details

I. General information

NPI: 1134489487
Provider Name (Legal Business Name): THOMAS PETER BRIDGE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/21/2012
Last Update Date: 05/21/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

340 KINGSLAND ST 1 4C40
NUTLEY NJ
07110-1150
US

IV. Provider business mailing address

4921-A LOWER MOUNTAIN RD
NEW HOPE PA
18938-9401
US

V. Phone/Fax

Practice location:
  • Phone: 973-562-6580
  • Fax:
Mailing address:
  • Phone: 973-545-6899
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084B0040X
TaxonomyBehavioral Neurology & Neuropsychiatry Physician
License NumberMD420802
License Number StatePA

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: