Provider Demographics
NPI:1225102049
Name:PEDERSEN, BRITTA (MD)
Entity Type:Individual
Prefix:
First Name:BRITTA
Middle Name:
Last Name:PEDERSEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 ELLENS WAY PO BOX 638
Mailing Address - Street 2:
Mailing Address - City:ALPINE
Mailing Address - State:NJ
Mailing Address - Zip Code:07620
Mailing Address - Country:US
Mailing Address - Phone:201-768-5577
Mailing Address - Fax:
Practice Address - Street 1:36 7TH AVE
Practice Address - Street 2:SUITE 418
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011
Practice Address - Country:US
Practice Address - Phone:212-255-0400
Practice Address - Fax:212-255-6577
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1192952084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP489129OtherOXFORD
NY724221OtherBC
NY00223441Medicaid
B19065Medicare UPIN
NY00223441Medicaid