Provider Demographics
NPI:1609937036
Name:EHNSTROM, BRYAN ANDREW (ATC)
Entity Type:Individual
Prefix:MR
First Name:BRYAN
Middle Name:ANDREW
Last Name:EHNSTROM
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:711 COLONIAL ARMS RD
Mailing Address - Street 2:
Mailing Address - City:UNION
Mailing Address - State:NJ
Mailing Address - Zip Code:07083-7607
Mailing Address - Country:US
Mailing Address - Phone:609-290-3436
Mailing Address - Fax:
Practice Address - Street 1:1033 SPRINGFIELD AVE
Practice Address - Street 2:
Practice Address - City:CRANFORD
Practice Address - State:NJ
Practice Address - Zip Code:07016-1528
Practice Address - Country:US
Practice Address - Phone:908-497-4368
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MT001362002255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer