Provider Demographics
NPI:1801291109
Name:DAVIS, BRITTANY
Entity type:Individual
Prefix:
First Name:BRITTANY
Middle Name:
Last Name:DAVIS
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 1:420 FRONT ST
Mailing Address - Street 2:PO BOX 578
Mailing Address - City:ELMER
Mailing Address - State:NJ
Mailing Address - Zip Code:08318-2177
Mailing Address - Country:US
Mailing Address - Phone:856-358-1500
Mailing Address - Fax:856-358-6985
Practice Address - Street 1:420 FRONT ST
Practice Address - Street 2:
Practice Address - City:ELMER
Practice Address - State:NJ
Practice Address - Zip Code:08318-2177
Practice Address - Country:US
Practice Address - Phone:856-358-1500
Practice Address - Fax:856-358-6985
Is Sole Proprietor?:No
Enumeration Date:2014-10-29
Last Update Date:2017-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018223363AM0700X
NJ25MP00396400363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA400112884Medicare PIN
NJ547691VY2Medicare PIN