Provider Demographics
NPI:1013513845
Name:BRY, ASHLEIGH
Entity Type:Individual
Prefix:
First Name:ASHLEIGH
Middle Name:
Last Name:BRY
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 1:4 WHIPPOORWILL DR
Mailing Address - Street 2:
Mailing Address - City:WOODBINE
Mailing Address - State:NJ
Mailing Address - Zip Code:08270-3003
Mailing Address - Country:US
Mailing Address - Phone:609-231-1203
Mailing Address - Fax:
Practice Address - Street 1:65 W JIMMIE LEEDS RD
Practice Address - Street 2:
Practice Address - City:POMONA
Practice Address - State:NJ
Practice Address - Zip Code:08240-9102
Practice Address - Country:US
Practice Address - Phone:609-652-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-08
Last Update Date:2020-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ01077600367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered