Provider Demographics
NPI:1396047783
Name:HART, BRIAN PATRICK (DC)
Entity type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:PATRICK
Last Name:HART
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:424 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:FORKED RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08731-4654
Mailing Address - Country:US
Mailing Address - Phone:609-971-3500
Mailing Address - Fax:609-971-3545
Practice Address - Street 1:3431 BERGEN AVE
Practice Address - Street 2:
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08753-4806
Practice Address - Country:US
Practice Address - Phone:732-270-8250
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-17
Last Update Date:2017-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00686800111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor