Provider Demographics
NPI:1790440758
Name:FORD, BRIDGET (PA)
Entity type:Individual
Prefix:
First Name:BRIDGET
Middle Name:
Last Name:FORD
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:535 E 70TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-4823
Mailing Address - Country:US
Mailing Address - Phone:212-606-1550
Mailing Address - Fax:212-606-1552
Practice Address - Street 1:519 E 72ND ST STE 204
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-4028
Practice Address - Country:US
Practice Address - Phone:212-606-1550
Practice Address - Fax:212-606-1552
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-04
Last Update Date:2024-08-02
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Single Specialty