Basic Information
| Provider Information | |||||||||
| NPI: | 1013513845 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BRY | ||||||||
| FirstName: | ASHLEIGH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4 WHIPPOORWILL DR | ||||||||
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| City: | WOODBINE | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 082703003 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6092311203 | ||||||||
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| Practice Location | |||||||||
| Address1: | 65 W JIMMIE LEEDS RD | ||||||||
| Address2: | |||||||||
| City: | POMONA | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 082409102 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6096521000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/08/2020 | ||||||||
| LastUpdateDate: | 12/08/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/08/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | 26NJ01077600 | NJ | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
No ID Information.