Provider Demographics
NPI:1023712080
Name:PYCH, BERNADETTE MARIA
Entity type:Individual
Prefix:
First Name:BERNADETTE
Middle Name:MARIA
Last Name:PYCH
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 1:409 JOYCE KILMER AVE UNIT 210
Mailing Address - Street 2:
Mailing Address - City:NEW BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08901-3363
Mailing Address - Country:US
Mailing Address - Phone:732-418-0709
Mailing Address - Fax:732-317-3064
Practice Address - Street 1:409 JOYCE KILMER AVE UNIT 210
Practice Address - Street 2:
Practice Address - City:NEW BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08901-3363
Practice Address - Country:US
Practice Address - Phone:201-725-1930
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-27
Last Update Date:2023-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MP00769300363AS0400X
NY029362-01207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery