Basic Information
| Provider Information | |||||||||
| NPI: | 1710353859 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | BRITTIAN | ||||||||
| FirstName: | JONATHAN | ||||||||
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| Credential: | AUD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 191 | ||||||||
| Address2: | PROVIDER ENROLLMENT DEPARTMENT | ||||||||
| City: | ROCKLAND | ||||||||
| State: | DE | ||||||||
| PostalCode: | 197320191 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3026516212 | ||||||||
| FaxNumber: | 3026514945 | ||||||||
| Practice Location | |||||||||
| Address1: | 3855 W CHESTER PIKE STE 280 | ||||||||
| Address2: | NEMOURS DUPONT PEDIATRICS, NEWTOWN SQUARE | ||||||||
| City: | NEWTOWN SQUARE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 190732304 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6105574800 | ||||||||
| FaxNumber: | 6105574816 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/12/2015 | ||||||||
| LastUpdateDate: | 09/22/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 231H00000X | O20000215 | DE | Y | Speech, Language and Hearing Service Providers | Audiologist |
No ID Information.