Healthcare Provider Details

I. General information

NPI: 1033866348
Provider Name (Legal Business Name): BRIDGETT CHIESA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/07/2022
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

435 HURFFVILLE - CROSS KEYS RD
SEWELL NJ
08080
US

IV. Provider business mailing address

9 HILLSIDE AVE
CLAYTON NJ
08312-2111
US

V. Phone/Fax

Practice location:
  • Phone: 856-582-2500
  • Fax:
Mailing address:
  • Phone: 570-234-5959
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZE0600X
TaxonomyElectroneurodiagnostic Specialist/Technologist
License Number8222
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: