MEDICARE: MRS. DENISE BRIGANDE RPA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	002391-1	NY

General Provider Information

NPI Number	:	1184953200
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. DENISE BRIGANDE RPA-C

Provider Business Mailing Address
First Line	:	84 W CLARK PL
Second Line	:
City	:	COLONIA
State	:	NJ
Zip	:	07067-2454
Country	:	US
Telephone Number	:	732-499-8180
Fax Number	:

Provider Business Practice Location Address
First Line	:	84 W CLARK PL
Second Line	:
City	:	COLONIA
State	:	NJ
Zip	:	07067-2454
Country	:	US
Telephone Number	:	732-499-8180
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/20/2009
Last Update Date	:	12/20/2009

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