Provider Demographics
NPI:1073737086
Name:DUNPHY, BERNADETTE A (DPT)
Entity Type:Individual
Prefix:DR
First Name:BERNADETTE
Middle Name:A
Last Name:DUNPHY
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 CORBETT WAY
Mailing Address - Street 2:
Mailing Address - City:EATONTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07724-2264
Mailing Address - Country:US
Mailing Address - Phone:732-542-8818
Mailing Address - Fax:732-389-6595
Practice Address - Street 1:300 BROAD ST
Practice Address - Street 2:
Practice Address - City:RED BANK
Practice Address - State:NJ
Practice Address - Zip Code:07701-2119
Practice Address - Country:US
Practice Address - Phone:732-275-3200
Practice Address - Fax:732-275-3210
Is Sole Proprietor?:No
Enumeration Date:2007-04-12
Last Update Date:2008-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00366000225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ4243993OtherAETNA
NJ648370P9LMedicare ID - Type Unspecified
NJ4243993OtherAETNA