Healthcare Provider Details

I. General information

NPI: 1689252702
Provider Name (Legal Business Name): BRYN OLIVIA GRIFFITH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2021
Last Update Date: 09/08/2024
Certification Date: 09/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

755 MEMORIAL PKWY STE 115
PHILLIPSBURG NJ
08865-2774
US

IV. Provider business mailing address

755 MEMORIAL PKWY STE 115
PHILLIPSBURG NJ
08865-2774
US

V. Phone/Fax

Practice location:
  • Phone: 484-658-5437
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number25MB12343400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: