Provider Demographics
NPI:1700393634
Name:CARDINALE, BRYAN SCOTT
Entity Type:Individual
Prefix:
First Name:BRYAN
Middle Name:SCOTT
Last Name:CARDINALE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5096 HACKBERRY LN
Mailing Address - Street 2:
Mailing Address - City:CLAY
Mailing Address - State:NY
Mailing Address - Zip Code:13041-8910
Mailing Address - Country:US
Mailing Address - Phone:315-657-8786
Mailing Address - Fax:
Practice Address - Street 1:5096 HACKBERRY LN
Practice Address - Street 2:
Practice Address - City:CLAY
Practice Address - State:NY
Practice Address - Zip Code:13041-8910
Practice Address - Country:US
Practice Address - Phone:315-657-8786
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-31
Last Update Date:2017-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)