Provider Demographics
NPI:1891767901
Name:PRYBICIEN, MICHAEL ANTHONY (ATC EMTB, CSCS)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:ANTHONY
Last Name:PRYBICIEN
Suffix:
Gender:M
Credentials:ATC EMTB, CSCS
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Mailing Address - Street 1:102 PATRICIA PL
Mailing Address - Street 2:
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07012-1855
Mailing Address - Country:US
Mailing Address - Phone:973-594-9651
Mailing Address - Fax:973-571-4170
Practice Address - Street 1:799 BLOOMFIELD AVENUE
Practice Address - Street 2:SUITE 304
Practice Address - City:VERONA
Practice Address - State:NJ
Practice Address - Zip Code:07044-1301
Practice Address - Country:US
Practice Address - Phone:973-571-0001
Practice Address - Fax:973-571-4170
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-02
Last Update Date:2012-06-27
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MT000621002255A2300X
PART001246A2255A2300X
NJ146N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, Basic