Provider Demographics
NPI:1679879829
Name:SPLAIN, BRIDGET ROSE
Entity Type:Individual
Prefix:MS
First Name:BRIDGET
Middle Name:ROSE
Last Name:SPLAIN
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 1:214 W 112TH ST APT 4F
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10026-3505
Mailing Address - Country:US
Mailing Address - Phone:301-807-0845
Mailing Address - Fax:
Practice Address - Street 1:1967 TURNBULL AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10473-2519
Practice Address - Country:US
Practice Address - Phone:718-842-1400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-07
Last Update Date:2011-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program