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General NPI Number Information
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NPI Number | 1932978376
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Entity Type | Individual
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Provider Name | MR. BRIAN PETERSON
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Gender | Male
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Dates
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Enumeration Date | 12/27/2023
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Last Update Date | 12/27/2023
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Provider Practice Location Address
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Address Line | 1071 US HIGHWAY 202 N
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City | BRANCHBURG
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State | NJ
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Zip | 08876-3924
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Country | US
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Telephone | 908-255-4763
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Fax |
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Provider Business Mailing Address
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Address Line | 8 RADIO CT
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City | SOMERSET
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State | NJ
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Zip | 08873-2040
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Country | US
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Telephone | 732-501-9185
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225800000X
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Taxonomy Name | Recreation Therapist
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License Number |
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License Number State |
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