Provider Demographics
NPI:1720456551
Name:CONCATO, BRIDGET M
Entity Type:Individual
Prefix:
First Name:BRIDGET
Middle Name:M
Last Name:CONCATO
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 1:11 PINE ST
Mailing Address - Street 2:
Mailing Address - City:ENGLISHTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07726-1513
Mailing Address - Country:US
Mailing Address - Phone:732-792-7300
Mailing Address - Fax:732-446-9126
Practice Address - Street 1:11 PINE ST
Practice Address - Street 2:
Practice Address - City:ENGLISHTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07726-1513
Practice Address - Country:US
Practice Address - Phone:732-792-7300
Practice Address - Fax:732-446-9126
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-10
Last Update Date:2015-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MT000820002255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer