Provider Demographics
NPI:1740686849
Name:NISSEL, BRYNA (RPA-C)
Entity type:Individual
Prefix:MRS
First Name:BRYNA
Middle Name:
Last Name:NISSEL
Suffix:
Gender:F
Credentials:RPA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:358 BEECH ST
Mailing Address - Street 2:
Mailing Address - City:HACKENSACK
Mailing Address - State:NJ
Mailing Address - Zip Code:07601-1344
Mailing Address - Country:US
Mailing Address - Phone:201-487-8600
Mailing Address - Fax:
Practice Address - Street 1:358 BEECH ST
Practice Address - Street 2:
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601-1344
Practice Address - Country:US
Practice Address - Phone:201-487-8600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-17
Last Update Date:2021-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1025198363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant