Provider Demographics
NPI:1114289881
Name:NASH, BRIDGET GALLAGHER
Entity Type:Individual
Prefix:MISS
First Name:BRIDGET
Middle Name:GALLAGHER
Last Name:NASH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:272 HENRY ST
Mailing Address - Street 2:APT A
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11201-4667
Mailing Address - Country:US
Mailing Address - Phone:213-446-6683
Mailing Address - Fax:
Practice Address - Street 1:272 HENRY ST
Practice Address - Street 2:APT A
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-4667
Practice Address - Country:US
Practice Address - Phone:213-446-6683
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-08
Last Update Date:2012-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY734775174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist