Provider Demographics
NPI:1629234653
Name:PATRICK, BRYAN L (MD)
Entity Type:Individual
Prefix:DR
First Name:BRYAN
Middle Name:L
Last Name:PATRICK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1213 HEMLOCK AVE
Mailing Address - Street 2:
Mailing Address - City:SEA GIRT
Mailing Address - State:NJ
Mailing Address - Zip Code:08750-1719
Mailing Address - Country:US
Mailing Address - Phone:201-895-1112
Mailing Address - Fax:
Practice Address - Street 1:1213 HEMLOCK AVE
Practice Address - Street 2:
Practice Address - City:SEA GIRT
Practice Address - State:NJ
Practice Address - Zip Code:08750-1719
Practice Address - Country:US
Practice Address - Phone:201-895-1112
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-30
Last Update Date:2008-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MAO5592300207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine