MEDICARE: DR. NICOLE JASMYN BRIGHT D.O

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	207N00000X	Dermatology Physician	OT011840	PA

General Provider Information

NPI Number	:	1578722856
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NICOLE JASMYN BRIGHT D.O

Provider Business Mailing Address
First Line	:	545 BECKETT RD
Second Line	:	SUITE 101
City	:	LOGAN TOWNSHIP
State	:	NJ
Zip	:	08085-1547
Country	:	US
Telephone Number	:	856-241-3311
Fax Number	:	856-241-3969

Provider Business Practice Location Address
First Line	:	545 BECKETT RD
Second Line	:	SUITE 101
City	:	LOGAN TOWNSHIP
State	:	NJ
Zip	:	08085-1547
Country	:	US
Telephone Number	:	856-241-3311
Fax Number	:	856-241-3969

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

Provider Enumeration Date	:	06/03/2008
Last Update Date	:	09/30/2013

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