Provider Demographics
NPI:1376130591
Name:BARDALL, MORGAN EDWARD (APN)
Entity Type:Individual
Prefix:DR
First Name:MORGAN
Middle Name:EDWARD
Last Name:BARDALL
Suffix:
Gender:M
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 BREMOND ST
Mailing Address - Street 2:
Mailing Address - City:BELLEVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07109-2735
Mailing Address - Country:US
Mailing Address - Phone:973-400-1706
Mailing Address - Fax:
Practice Address - Street 1:41 VILLAGE CT
Practice Address - Street 2:
Practice Address - City:HAZLET
Practice Address - State:NJ
Practice Address - Zip Code:07730-1535
Practice Address - Country:US
Practice Address - Phone:908-297-8849
Practice Address - Fax:231-251-8123
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-22
Last Update Date:2023-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ01090900363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health