Provider Demographics
NPI:1093431975
Name:BARTHOLOMEW, BRIELLA ROSE (NP)
Entity Type:Individual
Prefix:
First Name:BRIELLA
Middle Name:ROSE
Last Name:BARTHOLOMEW
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:622 W 168TH ST PH 12
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10032-3720
Mailing Address - Country:US
Mailing Address - Phone:212-305-4600
Mailing Address - Fax:212-305-8750
Practice Address - Street 1:173 FORT WASHINGTON AVENUE
Practice Address - Street 2:4TH FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10032
Practice Address - Country:US
Practice Address - Phone:212-305-4600
Practice Address - Fax:212-305-8750
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-13
Last Update Date:2023-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY310979363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health