Provider Demographics
NPI:1942711536
Name:TANADA, BRIAN (DPT)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:
Last Name:TANADA
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:70 HILLSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:NUTLEY
Mailing Address - State:NJ
Mailing Address - Zip Code:07110-1614
Mailing Address - Country:US
Mailing Address - Phone:973-666-1546
Mailing Address - Fax:
Practice Address - Street 1:150 N MIDLAND AVE
Practice Address - Street 2:
Practice Address - City:SADDLE BROOK
Practice Address - State:NJ
Practice Address - Zip Code:07663-5926
Practice Address - Country:US
Practice Address - Phone:201-712-5533
Practice Address - Fax:201-712-5551
Is Sole Proprietor?:No
Enumeration Date:2017-10-23
Last Update Date:2017-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01745700225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist